臺灣博碩士論文加值系統

有鑑於全民健康保險政策的導入，醫院面臨的挑戰更趨複雜。在既存的醫管相關研究中，傳統組織設計觀點提供了矩陣組織之概念，並透過此種組織結構來降低不確定性與複雜性。矩陣組織實際在管理上十分複雜，經營成本亦相當可觀，並不完全適用於台灣之醫院管理。
本研究之主要目的在於導入現今醫院管理之研究領域中較不被提及之水平跨單位整合機制之概念，進而建構一理想之醫院組織設計模式以取代現存之矩陣組織之概念，此一理論性架構可為重複試驗於各醫院層級規模，以達理論模式之一般性。採用水平跨單位整合機制主要是有助於改善醫療與醫管在本質上的對立與衝突，並且醫院管理者可以同時兼顧醫療成本問題與病患醫療品質問題。冀望藉由理論性新架構提供醫院管理及醫療產業面臨越趨複雜的經營環境時，一套可供依循的方向。
本研究嘗試導入Galbraith不同程度橫向協調選擇之組織設計概念並同時導入組織行為以人為重心之溝通概念，以建構一全新之管理手法。本研究將此管理手法定義為『水平跨單位整合機制（Horizontal Cross-Unit Integrated Mechanism）』依醫院規模區分為個人層次、團體層次與組織層次三種。
本研究採用個案研究法對理論性架構進行驗證，以台灣南部兩家不同規模等級醫院為研究對象。經過深度訪談後之結果發現，醫療產業確實依照不同複雜程度與規模大小採用不同程度之整合機制，例如個案醫院A為地區醫院，其採用之程度到達團體層次之整合性角色；個案醫院B為區域醫院其整合機制程度到達組織層次之高階管理部門。個案之結果驗證了本研究理論性架構之可行性。
本研究之重大結論為以下三點，首先，醫院組織乃由「醫療別+醫管別」之組織型態構成，醫院組織大都會朝矩陣組織型態發展，以解決其雙元權力之需求。在國外，矩陣組織於1970年代開始大量運用於醫療產業；在台灣近十年來，也慢慢在應用矩陣組織概念於醫院管理上。 其次，矩陣組織型態之醫療院所，不管是在國外或是台灣，均是有相當規模程度以上之醫院，甚少有中小型醫院採用矩陣組織，此乃因為建構矩陣組織必須花費相當高的建置成本與時間成本，中小型醫院並非可以負擔的起。最後，台灣醫療經營環境大部分仍屬中小型醫院，因此勢必要有一套新的理論架構來提供醫院管理一項管理的手段。在面對不同程度複雜性，應採用不同程度的統合機制，良好的組織設計也是一種競爭力的來源。

As result of the policy of National Health Insurance (NHI) interferes in Taiwan’s medical industry, hospitals face challenges which has more and more complicated. In existing hospital management studies, the traditional concept of organization design proposes the Matrix Organization Design to reduce the degree of complexity and uncertainty. However, for Taiwan’s hospitals the application of Matrix organizational structure is very complex and costly.
The main purpose of this study is leading in the concept of “Horizontal Cross-Unit Integrated Mechanism” which rarely is mentioned and further establishes a desirable hospital structure design to replace the existing concept of Matrix Organization. In order to achieve the generalization of theory model, this model could be retested in different size hospitals. Thus, hospitals adopt Horizontal Cross-Unit Integrated Mechanism that avails to improve the conflict between medical treatment and hospital in nature. And so hospital manager could care medical cost and medical quality in the same time. This study hopes the concept of theory structure offers hospital manager and medical industry a commend way when they confront more and more complicated operating environment.
In order to establish a new management approach for hospital management, the study adopts the Galbraith’s concept which proposed an Organizational Design with different levels of lateral communication choices, emphasizing on organizational behavior. The new approach was defined, in this study, as “Horizontal Cross-Unit Integrated Mechanism”. This approach divides integrated mechanism into three levels, namely, individual level, group level and organizational level.
This study adopts Case Study of Research Method to prove the theory framework, thus, the targets are the different size hospitals in the South Taiwan. By in depth interviews with senior manager, the findings indicate that hospitals factually apply different levels of Horizontal Cross-Unit Integrated Mechanism according to different complexity and size. Sample A is a community hospital which adopts the Horizontal Cross-Unit Integrated Mechanism up to group level. Sample B is a regional hospital which adopts the Horizontal Cross-Unit Integrated Mechanism up to organizational level.
The conclusions we have are as following:
First, hospital consists of medical treatment and hospital management, and hospital structure develops toward Matrix Organization to solve the needs of dual power. In abroad, Matrix Organization has begun to be applied extensively at medical industry in 1970’s. On the other contrary, in the recent decade hospitals have applied the concept of Matrix Organization on hospital management in Taiwan.
Second, whether hospitals apply Matrix Organization in overseas or in Taiwan, they both are quite size hardly ever medium and small size hospitals adopt Matrix Organization. Because it doesn’t afford the high establishment cost and time cost.
Finally, the medical environment most consists of parts of medium and small size hospitals. Thus, it must have a new theory structure to offer a administrant approach. To face with different levels of complexity, hospitals should adopt the different levels of Horizontal Cross-Unit Integrated Mechanism, a fine Organization Design also is a source of competitiveness.

目錄
摘要 I
Abstract IV
誌謝 VII
目錄 IX
圖表索引 XII
第1章 緒論 1
1.1 研究背景 1
1.2 研究動機 11
1.3 研究目的 14
1.4 研究流程 17
1.5 文章構成 19
第2章 文獻探討 20
2.1 矩陣組織的時代背景 20
2.2 矩陣組織的定義 29
2.3 矩陣組織的類型 37
2.4 矩陣組織於醫院管理之應用 45
2.5 矩陣組織於醫院管理應用之缺點 49
2.6 小結 54
第3章 理論性架構 59
3.1分析視點一：組織設計之觀點-Galbraith 水平統合 62
3.2分析視點二 : 組織行為之觀點-溝通 76
3.3理論性架構：水平跨單元整合機制 81
3.4 研究方法 91
3.5 小結 99
第4章 個案分析 101
4.1 研究對象 101
4.2個案醫院A 103
4.3個案醫院B 113
第5章 結論與課題 120
5.1 結論 120
5.2 研究貢獻 123
5.3 研究課題 125
參考文獻 126
中文部分 126
日文部分 128
英文部分 129
附錄 深度訪談執行表 135
作者簡介 142



















圖表索引
圖1- 1 實施保險制度以來，門診量之趨勢圖 5
圖1- 2 不同西醫醫院數消長圖 6
圖1- 3 本研究流程圖 18
圖2- 1 Mee(1964) 最早提出之矩陣組織型態圖 21
圖2- 2 職能導向之組織型態 27
圖2- 3 服務導向之組織型態（產品別） 27
圖2- 4 產品別組織 33
圖2- 5 顧客別組織 33
圖2- 6 地域別組織 34
圖2- 7 程序別組織 34
圖2- 8 專門別組織 35
圖2- 9 常見之矩陣組織型態圖 35
圖2- 10 以組織配置為基礎之矩陣型態圖 36
圖2- 11 相對權力觀點下之組織連續性轉變圖 37
圖2- 12矩陣組織的類型 39
圖2- 13職能矩陣 40
圖2- 14專案矩陣 41
圖2- 15平衡矩陣 42
圖2- 16 混合編成原理下之組織 43
圖3- 1 研究設計架構圖 61
圖3- 2 組織設計的策略所經歷的過程 65
圖3- 3 創造橫向關係之選擇性方法 69
圖3- 4 協商數 80
圖3- 5 水平跨單位整合機制模式圖 81
圖3- 6 統合機制分類標準 86
圖3- 7 一般診所之組織圖 87
圖3- 8 中部某地區醫院組織圖 88
圖3- 9 南部某區域醫院組織圖 89
圖4- 1 個案醫院A組織圖 105
圖4- 2 個案醫院A導入整合機制前組織圖 109
圖4- 3個案醫院B組織圖 117
圖5- 1 理論性架構與實證結果對照表 122












表1- 1 2000～2005年我國醫療與保健支出占GDP的比例 2
表1- 2 2000～2005年各國醫療與保健支出占GDP的比例 3
表1- 3 近五年我國65歲以上人口數與百分比 7
表1- 4 醫院的歷史變遷與未來所面臨的複雜性環境之三環境構面 9
表2- 1 Galbraith(1973) 之橫向組織關係 24
表2- 2 各學者對矩陣組織定義之彙整 31
表2- 3 醫院人事管理模式 48
表2- 4 矩陣組織的優缺點 49
表2- 5 醫院矩陣組織的優缺點 51
表2- 6 企業策略與結構 56
表3- 1 Galbraith(1974) 水平統合表 73
表3- 2 衡量複雜性的指標 84
表3- 3 醫療網計畫下之醫院分級 85
表3- 4 統合機制之適用分類表 90
表3- 5統合機制之適用量表 90
表3- 6 量性與質性方法比較表 92
表3- 7 個案研究之證據性質料來源及其優缺點 95
表3- 8 模式觀點比較 99
表4- 1 個案醫院A病床數 106
表4- 2 個案醫院A專科醫師人數 106
表4- 3 個案醫院A醫事專門職業人員 107
表4- 4 個案醫院Ａ行政與其他人員 107

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