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題名 | 醫院策略強調對醫師專業自主影響之跨層次分析:層級線性模式的應用=A Cross-Level Analysis of Hospitals Strategic Emphasis on Physician Professional Autonomy: An Hierarchical Linear Modeling |
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作者 | 汪秀玲; 黃俊英; Wang, Hsiu-ling; Huang, Jun-ying; |
期刊 | 人力資源管理學報 |
出版日期 | 20101200 |
卷期 | 10:4 2010.12[民99.12] |
頁次 | 頁33-54 |
分類號 | 419.24 |
語文 | chi |
關鍵詞 | 專業自主; 策略強調; 報償誘因; 跨層次研究; 層級線性模式; Professional autonomy; Strategic emphasis; Compensation incentive; Cross-level research; Hierarchical linear modeling; |
中文摘要 | 目標:從系絡觀點檢視台灣導入總額支付制度後,醫院策略強調對醫師專業自主之衝擊。材料與方法:針對參加自主管理方案245家醫院,便利抽樣84家區域級以上醫院,於2008年發出84份主管問卷和1,280份醫師問卷,採暗記方式將隸屬同一醫院的醫師予以彙總,有效樣本計43份主管及409份醫師資料,代表醫院和醫師回收率爲51.19%、31.95%。結果:專業自主四個次向度(管理監督、掌控處置、組織地位及工作負荷)的層級線性模式分析顯示,當醫院執行成本抑制策略,對醫師感受管理監督有正向系絡直接影響(0.179, p<.01),對掌控醫療處置及地位的感受有負向系絡直接影響(-0.191, -0.096, p<.05),反之,收入創造策略對三個次向度則有相反方向的系絡效果(-0.103, 0.130, 0.174, p<.05)。風險承擔的變動報償會增加管理監督感受但未達顯著水準(0.189, p>.05),層級別(醫學中心vs.區域醫院)對工作負荷(0.117, p<.05),健保區域別(北部vs.其他)對掌控醫療處置(-0.362, p<.05)皆有系絡效果。個體層次變項中,專科別、教育程度對自主感受有預測效果。整體而言,個體層次變項解釋專業自主12.89%-30.98%群內變異,組織層次變項解釋55.20%-75.37%群間變異。結論:本文實證組織系絡會形塑醫師自主的感受,也不應忽視個人特徵的影響。 |
英文摘要 | Objectives. To examine the contextual effects of hospital strategic emphasis on physician professional autonomy after Hospital Global Budgeting (HGB) implemented. Methods. We chose 84 teaching hospitals participated at the HGB and sent survey packages to these hospitals in 2008. Each package contained copies of physician questionnaire and a manager questionnaire. A total of 409 usable physician surveys and 43 manager surveys were analyzed, a number representing approximate response rates of 51.19 percent for the hospitals and 31.95 percent for the physicians. We conducted hierarchical linear modeling using individual reported autonomy as the outcome variable. Results. Implementation of cost containment strategy increased physician's recognition of administrative supervision, and decreased physician's control over his/her work and status in hospital (0.179, p<.01; -0.191, p<.05; -0.096, p<.05), whereas a strategy of revenue generation disclosed reverse influence on above-mentioned perceptions (-0.103, 0.130, 0.174, p<.05). The variable compensation level based on risk taking leads to physicians perceived administrative restrictions but not significantly (0.189, p>.05). Also, the hospital rank and location had a contextual effect on physician's work loading and control treatment separately (0.117, -0.326, p<.05). At the individual level of analysis, our findings show that physician's specialty and education degree also had a significant impact on their perceived autonomy. Overall, the individual-level factors explained 12.89%-30.98% within-hospital variance on autonomy and hospital-level factors explained 55.20%-75.37% between-hospital variance. Conclusions. We demonstrated that organizational factors have a significant cross-level influence on physician’s perceptions of professional autonomy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。