醫師如何看待醫院的企業化經營管理趨勢

How Do Physicians Regard Managerial Intervention in Hospitals?

丁志音(Chih-Yin Lew-Ting)

《中華公共衛生雜誌》 18卷2期 (1999/04) Pp. 152-166

https://doi.org/10.6288/CJPH1999-18-02-08

摘要

管理之應用於醫院及其他醫療機構已成一種世界趨勢，台灣也不例外。本研究試圖探索1702名醫師對此一趨勢的態度及批判。研究資料來自於一項對全省執業西醫師的郵寄問卷調查。以質性方法對其中之698名醫師的書面意見分析後發現：(1)經濟誘因，如效率、成本效益、善用資源及提昇服務品質等，是對企業化經營管理予以正面評價之醫師最關注之處，(2)商業化、缺乏人性及情感、專業自主權的喪失、以及醫病關係之惡化乃持負面價值之醫師最詬病之處，(3)不過，另有一些持肯定看法的醫師提出兩類論點，一為譴責大型企業與政府；另一類則恰好相反，對此趨勢抱著悲觀的、宿命的看法，認為此趨勢只不過反映了大環境的變遷罷了，是「無法避免」的。本研究結果顯示，在企業化經營管理之策略下，醫師之調適不佳。進一步探索衛生專業人員對管理的反應，將有助於在目前的健康照護環境中造就正向的文化與互動關係。

關鍵字

管理 ； 醫師 ； 專業性 ； 商業化 ； 醫病關係

並列摘要

The application of management interventions in hospitals and other health care settings is a worldwide phenomenon, and Taiwan is no exception. This study explored 1702 physicians' perceptions of and criticism towards current managerial strategies in hospitals in Taiwan. Data for the analysis came from a nation-wide mail survey of active physicians. Qualitative analysis of the comments from 698 out of 1702 physicians revealed that: (1) economic appeal-efficiency and cost-benefit in the use of resources and therefore improving quality of care-is the highest concern among physicians who held a positive stance towards managerial intervention, (2) commercialization, lack of humanitarianism and compassion, erosion of professional autonomy, and deterioration of the physician-patient relationship were adverse effects which were of great concern to physicians who held a negative stance toward managerial intervention, (3) among a subgroup that professed pro-management attitudes, two types of comments were disclosed: one radically condemned the large corporations and the government, and the other, somewhat fatalistic and pessimistic in tone, considered that managerial intervention in health care reflects a global trend of social change and is thus ”inevitable.” The results of this study indicate that most physicians are not well adjusted to the corporatized health care system. Further exploration of the health professionals' responses to a corporate managerial techniques is instructive to construct a positive culture and improve worksite interaction in current health care community.

並列關鍵字

Managerial interventions ； physicians ； professionalism ； commercialization ； patient-physician relationship