醫療照護整合如何影響醫院績效？ —知識整合與雙元俱存的中介效果

How Health Care Integration Influences Hospital’s Performance? ̶ The Mediating Roles of Knowledge Integration and Ambidexterity

劉紫娟(Tzu-Chuan Liu)

指導教授 ： 嚴奇峰 ； 黃銘章

中原大學/商學院/企業管理研究所/博士(2017年)

https://doi.org/10.6840/cycu201700401

摘要

隨著醫療技術的進步與醫療專科化的增加，疾病模式的改變與人口老化，需要更多的醫療照護整合服務。醫院是眾多的專業人員，在彼此相互依賴的關係下，提供醫療照護的複雜組織，品質和安全是首要重點，若照護提供者之間缺乏合作，可能會導致無效和不安全醫療。醫療照護整合可以增強各個專業醫療提供者之間的連結，以即時、有效、適當的貢獻其專業知識與技術，有助於提升醫療品質與確保病人安全，實現以病人為中心的醫療服務，顯示醫療照護整合的重要性。
然而，對於醫療照護整合，醫院需要投入相當的資源，雖然過去已經有若干研究開始探討此議題，瞭解醫療照護整合程度與醫院營運效率及醫療品質成果之間的關係，但在研究的理論主張與實證結果仍相當分歧。因此，回答醫療照護整合如何對醫院績效產生正向影響的問題是重要的。
本研究提出知識整合與雙元俱存，可能在醫療照護整合與醫院績效的關係之間扮演中介角色。從84家急性病床100床以上之健保特約醫事機構實證結果顯示，醫療照護整合對醫院績效有顯著影響。此外，雖然知識整合的中介效果未達顯著水準，但雙元俱存這種動態能力在醫療照護整合與醫院績效之間具有顯著中介效果。

關鍵字

醫療照護整合 ； 知識整合 ； 雙元俱存 ； 醫院績效 ； 中介效果

並列摘要

The demand for health care integration services is increasing amid advancements in medical technologies and specializations, changes in disease patterns, and exacerbation of population aging. Hospitals are complex organizations, wherein a network of coreliant professionals work together to provide medical care. Quality and security are crucial elements in hospitals, and poor cooperation among care providers increase the likeliness of medical malpractice. Therefore, health care integration can strengthen the relationships of professional medical providers and effectively improve medical quality and ensure patient safety by encouraging practitioners to appropriately and effectively contribute their professional knowledge and skills in a timely manner, thereby providing patient-centered medical services. These advantages highlight the importance of health care integration.
However, integrating health care demands hospitals to invest a considerable amount of resources. Although a number of previous studies have focused on the relationships between health care integration, hospital operational efficiency, and medical quality, theoretical propositions and empirical results remain considerably controversial. Therefore, it is crucial that the positive effects of health care integration on hospital performance be elucidated.
This study proposed that knowledge integration and ambidexterity may mediate the relationship between health care integration and hospital performance. The empirical results of 84 medical care institutes that are covered by the National Health Insurance Scheme and offer 100 or more acute care beds show that health care integration significantly affected hospital performance. Although the mediating effect of knowledge integration was not significant, the ambidexterity did significantly mediate the relationship between health care integration and hospital performance.

並列關鍵字

Health care integration ； Knowledge integration ； Ambidexterity ； Hospital performance ； Mediating Effect

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