臺灣博碩士論文加值系統

顧客滿意度是關乎企業長期存活的能力，在現今高度競爭的醫療照護服務業中，提高病患滿意度以留住現有病患、降低其轉院意願、吸引新病患以增加醫療院所各科室使用率，已是醫療服務產業永續經營的重要關鍵因素。本研究試圖以關係行銷觀點與推敲可能性模式為基礎，來探討影響顧客滿意度的多重來源。本研究以醫師特質(專業性與親和力)、護理人員特質(照護能力與溝通技巧)與醫療院所特質(聲望與就醫替代性)為滿意度的多重來源，分析此三者其與洗腎者接受治療服務滿意度的關係，並進一步探討醫師滿意度、護理人員滿意度意在醫師特質、護理人員特質與洗腎者對醫療院所滿意度的中介影響關係。
本研究以台灣北、中、南三個地區的四家透析中心之洗腎者為對象，進行問卷調查。以研究者所編製的「醫療院所與洗腎者關係研究問卷」量表為工具，共發出調查問卷296份，有效回收問卷210份，有效回收率為71%。採用結構方程式：偏最小平方法(PLS-SEM)進行問卷資料分析與驗證研究架構模型。研究實證結果顯示：
一、醫病關係滿意度影響來源方面：(一)醫師的專業性與親和力會正向影響洗腎者對醫師滿意度；(二)護理人員的照護能力與溝通技巧會正向影響洗腎者對護理人員滿意度；(三)醫療院所的聲望會正向影響洗腎者對醫療院所滿意度，但是醫療院所的就醫替代性會負向影響洗腎者對醫療院所滿意度。
二、醫病關係滿意度中介角色方面：(一)洗腎者對醫師滿意度在醫師特質與洗腎者對於醫療院所滿意度間，扮演著中介的角色；(二)對護理人員的滿意度進一步分析發現，護理人員滿意度可以直接提高洗腎者對醫師滿意度、洗腎者對醫療院所滿意度；且護理人員滿意度亦可正向調節洗腎者對醫療院所滿意度。
是以本研究證實：病患對醫療院所滿意度的來源是多重的。以對醫師特質和醫療院所特質所產生的滿意度為主，對護理人員特質所產生的滿意度為輔。對醫師的滿意度和對醫療院所的滿意度會直接影響到病患對醫療院所的總體滿意度；而對護理人員的滿意度是要透過且當作醫師滿意度和醫療院所聲望的前置因素才能正向影響。本研究可提供透析醫療院所對提升洗腎者滿意度具體的管理作法，亦可考慮應用在與血液透析具有類似服務特性：高度差異性、直接密切顧客聯繫與高可信性品質的服務業之中。綜之，在訂定透析中心病患滿意策略時，應該首先增加病患對醫師與醫療院所滿意度，並且需要護理人員的配合。

The relevance of customer satisfaction in healthcare services has been widely investigated and assessed by the literature. Following an increase in positive evidence, the focus on customer satisfaction has become a primary goal, especially in the dialysis industry. A full understanding of its antecedents has therefore become a critical issue for both researchers and practitioners.
Drawing on relationship marketing theory and elaboration likelihood model, this study develops a conceptual framework of multi-sources of customer satisfaction in the healthcare context and examines the relationships between physician attributes (i.e., professionalism and affinity), nurse attributes (i.e., care ability and communication skills), attributes of healthcare facilities (i.e., prestige and replacement from competing healthcare facilities) and patient satisfaction in dialysis centers. This study also investigates the mediating effects of satisfaction on relationship between physician and nurse attributes on dialysis patients satisfaction.
A questionnaire survey was conducted on outpatients in four dialysis centers of Taiwan to verify the validity of the research framework. A total of 296 copies of questionnaire of questionnaire were distributed, and 210 valid copies were retrieved, with a valid response rate of 71%. The partial least square structural equation modeling (PLS-SEM) were applied for statistical analysis. PLS-SEM clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, PLS-SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, PLS-SEM was used to test the hypotheses.
The results show that the physician attribute and nurse attributes has a positive impact on the patient satisfaction toward dialysis center. Moreover, the satisfaction of dialysis patients is found to be positively impacted by the level of healthcare facilities prestige, but is negatively impacted by the level of replacement from competing healthcare facilities. The findings of this study also reveal that the satisfaction has a positive mediating effect on relationship between physician attributes on dialysis patient satisfaction. The findings broaden existing understanding about the determinants of patient satisfaction ,extracted to help dialysis centers better revise their existing marketing strategies to strength patient satisfaction.

摘 要……………………………………………………………………………………I
Abstract……………………………………………………………………………….III
誌 謝……………………………………………………………………….…………IV
第一章 緒論…………………………………………………………………….1
第一節 研究背景與動機………………………………………………….1
第二節 研究目的………………………………………………………….5
第三節 研究步驟………………………………………………………….7
第三節 名詞釋義………………………………………………………...11
第二章 文獻探討……………………………………………………………….15
第一節 台灣透析醫療產業現況與發展………………………………...15
第二節 洗腎者滿意度影響來源之探討………………………………...31
第三節 醫師特質與洗腎者對醫師滿意度的關係……………………...41
第四節 護理人員特質與洗腎者對護理人員滿意度的關係…………...43
第五節 洗腎者對醫療院所滿意度的影響來源………………………...45
第六節 醫師滿意度與護理人員滿意度的中介角色…………………...49
第三章 研究方法……………………………………………………………….51
第一節 研究架構及研究變數操作性定義……………………………...51
第二節 研究假說………………………………………………………...58
第三節 研究工具………………………………………………………...63
第四節 資料分析方法…………………………………………………….68
第四章 研究結果分析與討論…………………………………………………..70
第一節 受試者之人口統計變數分析…………………………………..70
第二節 醫師特質、護理人員特質、醫療院所特質對洗腎者滿意度影響來源關係之分析…………………………………...73
第三節 中介變數—醫師滿意度之分析………………………………...80
第四節 中介變數—護理人員滿意度之分析…………..……………….82
第五章 結論與建議…………………………………………………………….86
第一節 研究結論………………………………………………………...86
第二節 建議……………………………………………………………...91
第三節 研究限制與後續研究建議……………………………………...95
參.考文獻……………………………………………………….……………………...97
附錄 一 醫療院所與洗腎者關係研究卷……………………………………………114

表目錄
表 2-1 透析醫療器材製造商與代理商一覽表………………………………………...18
表 2-2 透析治療專用藥品製造商與代理商一覽表……………………………………19
表 2-3 腎臟透析營養產品製造商與代理商一覽表……………………………………20
表 2-4 台灣透析醫療照護服務供應商一覽表………………………………………...25
表 2-5 台灣透析醫療照護商透析中心家數2003 年與2013 年十年比較……………..26
表 2-6 台灣醫療院所透析中心數及洗腎者數2005 年與2013 年比較………………..29
表 2-7 顧客與病患滿意度定義探討…………………………………………………...39
表 3-1 醫師專業性與親和力操作性定義與問卷題項…………………………………53
表 3-2 護理人員照護能力與溝通技巧操作性定義與問卷題項………………………54
表 3-3 醫療院所聲望與就醫替代性作性定義與問卷題項……………………………55
表 3-4 中介變數「洗腎者對醫師滿意度」、「洗腎者對護理人員滿意度」之
操作型定義及問卷題項……………………………………………………….56
表 3-5 依變數「洗腎者對醫療院所滿意度」之操作型定義及問卷題項……………..57
表 3-6 透析中心基本資料分析………………………………………………….…….65
表 3-7 問卷回收分析………………………………………. ………………………...65
表 3-8 問卷信度檢定表……………………………………………………………………66
表 3-9 問卷效度檢定………………………………………………………………………67
表 4-1 研究樣本基本資料分析……………………………………………………………72
表 4-2 滿意度相關變數之路徑分析與假說驗證表………………………………………75
表4-3 滿意度相關研究假說驗證結果……………………………………………………79
表4-4 中介變數—醫師滿意度之假說驗證結果…………………………………………81

圖目錄
圖1-1 研究流程……………………………………………………………………………10
圖2-1 台灣透析醫療產業的組成…………………………………………………………17
圖3-1 研究架構圖…………………………………………………………………………51
圖4-1 研究架構模型路徑係數圖與分析結果……………………………………………74
圖4-2 洗腎者「對護理人員滿意度」為洗腎者「對醫療院所滿意度」
的前因效果路徑係數圖與分析結果………………………………………………83
圖4-3 洗腎者「對護理人員滿意度」為洗腎者「對醫療院所滿意度」
的調節效果路徑係數圖與分析結果………………………………………………84

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