醫院治理機制對治理效能之影響：以一家非都會區公立醫院心血管中心為例

Abstract

本研究旨在探討公立、非都會區醫院的治理機制如何影響其治理效能，並以該院心臟血管醫學中心為個案，深入剖析其在複雜且能才取得困難的醫療環境中，醫院如何透過有效的治理模式讓該院心血管中心實現轉型與卓越並取得出眾的治理效能。研究背景源於心血管疾病日益嚴重的威脅，尤其在交通不便、醫療資源相對缺乏的偏鄉，心臟急症病患過去常因延誤就醫而錯失治療黃金時間。為此，醫院於成立心血管中心，其首要任務不僅是提供醫學中心等級的醫療服務，更肩負了改善在地醫療困境的重大社會責任。 醫院治理與一般商業公司治理存在根本的差異。相較於營利企業以股東利益最大化為目標，醫院因其高度公益性與公共財特性，治理效能的評估必須擴展至社會責任、顧客、內部流程、學習與成長及財務等五個面向。本研究借鑑過去研究的理論模型，並以上述醫院與該院心血管中心為案例，探討治理機制中的「治理結構」、「資訊揭露透明度」與「決策機制」如何影響治理效能。文獻結果顯示，資訊揭露越透明、決策機制越完善，醫院的治理效能就越高，這有助於建立信任、合理分配資源並有效營運。然而，研究也發現，與營利公司不同的是，董事會治理結構（如規模、家族董監比率等）與醫院治理效能並無顯著關聯 。 本研究個案在成立之初便秉持「拓荒者」精神，從零開始建構在地醫療能量。其治理模式的成功，體現於以下幾項關鍵作為，包括 (1) 人才與團隊建構：初期透過鼓勵年輕醫師下鄉服務並提供誘因，同時以在地招募技術人員來提高留任率，並提供完整訓練，確保專業品質與在地連結性。(2) 策略性創新與整合：面對急重症醫療挑戰，該中心不僅建立了全天候緊急會診機制，更將觸角向外延伸，與當地消防局合作，並與友院啟動「區域聯防」模式，大幅改善治療預後。(3) 以病人為中心的文化塑造：該中心不僅注重急症照護，也將服務延伸至出院後的照護，並透過品質改善活動提升實證醫療達成率。此外，並與科技公司合作推動遠距居家監測，實踐虛實整合，為交通不便的高齡患者提供便利的後續照護。

總結來說，本研究透過個案分析，印證了在公立非都會區醫院的治理中，「資訊揭露透明度」與「決策機制」是影響顧客、社會責任、內部流程、學習與成長、及財務五大治理效能的關鍵因素。而由於院方領導人持續性的軟硬體投資與促進品質提升中居功厥偉，加以醫院治理層級的有效決策與透明化管理帶動全院自上而下的組織文化改造，使心血管中心得以取得了多項重要成就，共同實現了「提供醫學中心級醫療」的願景，所以本研究認為治理架構對治理效能的改善一樣功不可沒。 本案例的成功經驗顯示，透過完善的治理機制，非都會區醫院不僅能克服先天環境的限制，更能積極回應社區需求，承擔社會責任，最終提升醫療服務品質與民眾信賴感，實現永續發展，亦即治理效能的最佳展現。本研究為醫務管理領域提供了寶貴的本土實證案例，並為其他醫院提供了可供參考的治理模式與發展策略。

This study aims to investigate how governance mechanisms of public, non-urban hospitals affect their governance effectiveness. It uses the cardiovascular medical center of the hospital, as a case study to deeply analyze how the hospital, in a complex environment with talent acquisition difficulties, achieved transformation and excellence through an effective governance model, leading to outstanding governance effectiveness. The research background stems from the growing threat of cardiovascular diseases, especially in rural areas with inconvenient transportation and limited medical resources, where patients with cardiac emergencies often missed the golden hour for treatment due to delayed care. To address this, the hospital established the cardiovascular center, and its primary mission is not only to provide medical center-level care but also to shoulder the significant social responsibility of improving local healthcare challenges. The governance of hospitals and that of general commercial companies fundamentally differ. Unlike for-profit enterprises that aim to maximize shareholder value, hospitals, due to their high public welfare and public good nature, must evaluate their governance effectiveness across five dimensions: social responsibility, customer satisfaction, internal processes, learning and growth, and financial performance. This study, using a theoretical model from prior research and taking the aforementioned hospital and its cardiovascular center as a case, explores how governance mechanisms, including "governance structure," "information disclosure transparency," and "decision-making mechanisms," affect governance effectiveness. The literature review indicates that greater transparency in information disclosure and more robust decision-making mechanisms lead to higher hospital governance effectiveness, which helps build trust, allocate resources rationally, and operate efficiently. However, the study also finds that, unlike in for-profit companies, the board's governance structure (e.g., size, ratio of family board members) has no significant correlation with hospital governance effectiveness. The case study, the cardiovascular center, adopted a "pioneer" spirit from its inception, building local medical capacity from the ground up. The success of its governance model is reflected in several key actions, including: (1) Talent and Team Building: Initially, it encouraged young doctors to serve in the countryside and offered incentives, while recruiting local technical staff to increase retention rates. Comprehensive training was provided to ensure professional quality and local connection. (2) Strategic Innovation and Integration: Facing the challenges of critical and emergency care, the center not only established a 24-hour emergency cardiac consultation mechanism but also extended its reach by collaborating with the local fire department and other hospitals to launch a "regional defense" model. (3) Patient-Centered Culture Building: The center focuses not only on emergency care but also extends its services to post-discharge care. Through quality improvement activities, they achieved better attainment of evidence-based medical care. Furthermore, it collaborates with technology companies to promote remote home monitoring, integrating virtual and real services to provide convenient follow-up care for elderly patients with mobility issues. In conclusion, this study, through its case analysis, confirms that in the governance of public, non-urban hospitals, "information disclosure transparency" and "decision-making mechanisms" are key factors influencing the five major dimensions of governance effectiveness. Because of the leadership's continuous investment in both hardware and software and their significant contributions to quality improvement, along with the effective decision-making and transparent management at the hospital governance level that drove a top-down organizational cultural transformation, the cardiovascular center achieved numerous significant accomplishments, collectively realizing the vision of "providing medical center-level care." Therefore, this study believes that the governance framework is equally crucial for improving governance effectiveness. The success of this case demonstrates that through a sound governance mechanism, a non-urban hospital can not only overcome the limitations of its inherent environment but also actively respond to community needs, fulfill social responsibilities, and ultimately enhance the quality of medical services and public trust, which is the best manifestation of governance effectiveness. This study provides a valuable local empirical case for the field of healthcare management and offers a governance model and development strategies for other non-urban hospitals.