臺北市立聯合醫院治理模式建置之研究─制度變遷理論的觀點

The Research on Construction of Taipei City Hospital: The View of Institutional Change Theory

葉承鑫(Chen-Hsin,Yeh)

指導教授 ： 劉坤億

國立臺北大學/公共事務學院/公共行政暨政策學系/碩士(2009年)

摘要

臺北市立醫院因面臨醫療市場的轉變，以及全民健保制度的衝擊，自2005年起將十家市立醫院加以整併，以聯合醫院治理模式改善醫院營運績效，並且維持市立醫院在公共衛生上的角色。然而，此段治理模式建置過程，受到外在環境變遷及本身角色定位之影響，在制度環境的侷限之下，進行不斷地動態調整以尋求利基。本研究運用文獻分析與深度訪談法，探究臺北市立聯合醫院治理模式自2005年成立至今這段期間，其治理模式如何運作及變遷等相關事項。另外，本研究以制度變遷理論為基礎，提出分析架構，並輔以治理理論，除欲解析制度環境形塑治理模式建置之脈絡外，亦探討治理模式中多元行動者的角色及互動關係，以及治理模式建置之結果。最後，進一步地針對研究發現作理論檢證，並提出實務及後續研究建議。
本研究發現，臺北市立聯合醫院治理模式建置受到制度環境的侷限及驅使，在既定的框架中，進行一連串的動態調整，以追求組織的永續經營。綜言之，本研究個案之建置，呈現下列特色：
一、 因營運績效不彰，及因應醫療環境快速變遷，而推動治理模式建置
二、 SARS事件扮演了重要的觸媒角色；
三、 地方首長及主管機關首長的思維，牽引了治理模式建置的方向；
四、 市議員作為多方利益的代言人，介入建置過程之中；
五、 組織文化上的差異，致使治理模式無法順利落實；
六、 缺乏下而上的意見溝通，無法凝聚集體共識，導致建置面臨許多反對聲浪；
七、 聯合醫院治理模式仍不斷地進行調整，在績效與公共利益中尋求平衡點。
值得一提的是，本研究亦發現，制度環境對治理模式建置的影響雖大，但在本研究個案中，由決策菁英所組成的關係網絡，其發揮出的影響力，不僅使大規模的組織變遷方案得以推動，更一定程度地形塑整個治理模式建置的方向。

關鍵字

臺北市立聯合醫院、制度變遷、治理模式、新制度論

並列摘要

Because of the change of medical market and the impact of National Health Insurance, ten Taipei City hospitals were merged into one hospital in 2005.The integration of hospitals can improve the operational efficiency and maintain the characteristics in public health. However, the process of the construction of governing model was affected by the external environmental changes and the one’s position in public health, adjusted itself continuously in order to seek niche under the constraints of institutional environment. The author discussed the process and the change of governing model of Taipei City hospitals from 2005 by document analysis and in-depth interview. In addition, this research proposed the methodology in the basis of institutional change theory and governance theory, besides to understand the details of institutional environment mould the construction of governing model, the research also analyzed the role and the interaction of multiple actor and the result of the construction of governing model. Finally, the author tested the theory of discovery and addressed suggestions of practice and follow-up study.
The research discovered that the construction of Taipei City hospital governing model was limited to the institutional environment, which also adjusted dynamically to seek the sustainable development. To sum up, this research case shows list characteristic:
1. It drove the building of governance model because of operational inefficiency and the fast change of medical environment.
2. The SARS played the important catalyst in this research case;
3. The thought of leader directed the way of building of governance model.
4. The councilors play roles as the mediator of multiple-interest, and intervene in the process of construction.
5. The difference of organization culture made the governance model work unsuccessfully.
6. The constructing process faced lots of objection because of lacking of communication which led to a common consensus.
7. The governance model is still adjusted continuously and seeking for the balance point between efficiency and public interest.
There is something we could notice, this research also found one important: in this case, although the environmental impacts on construction of governing model is great, the relationship network organized by decision-elite not only promote this organizational change scheme, but also shape the direction of the construction of governing model.

並列關鍵字

Taipei City Hospital, institutional change, governing model, new institutionalis

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