組織整併後病患變革知覺及服務品質知覺與就醫忠誠度之關聯性研究―以國軍某醫療機構為例

Abstract

時代環境改變、國防預算縮減，國軍醫院必須配合現階段國防政策，進行組織精簡及合併，值此之際，如何提升病患對組織變革知覺及服務品質知覺的滿意度，以提升其就醫忠誠度，實為國軍醫院永續生存之要務。本研究採橫斷式問卷調查法，以三軍總醫院（醫學中心等級）整併國軍基隆醫院（地區醫院等級）之個案為例，探討個案醫院組織整併1年後（自93年11月至94年10月止），病患的變革知覺、服務品質知覺與就醫忠誠度之關聯性，期望找出影響就醫忠誠度的重要因子，提供個案醫院正面的策略方案或因應措施，以刺激並提升病患就醫忠誠度。研究母群體共4428人，其中可獲得完整地址者共1720人，以此為調查對象（佔母群38.8%），共回收問卷463份（回收率26.9%），問卷有效率達100%。經雙變項統計分析發現，「職業別」、「有無到過其他醫院看診經驗」、「病患的變革知覺情形」、個案醫院組織變革後「病患期望的服務品質」、「實際知覺的服務品質」、期望與實際知覺差異的滿意程度中的「有形性」、「可靠性」、「關懷性」及「整體性」等服務品質構面皆與就醫忠誠度達顯著相關。進一步以逐步回歸分析後發現影響就醫忠誠度之重要因素包括：（1）職業為學生、家管、退休或無業者、（2）對個案醫院組織變革後的各項服務認知會更好者、（3）對個案醫院的有形性服務品質實際知覺滿意者、（4）對個案醫院的反應性服務品質期望較高者、（5）對個案醫院的保證性服務品質實際知覺滿意者、（6）對個案醫院的關懷性服務品質實際知覺滿意者、（7）對個案醫院的可靠性服務品質期望與實際知覺之差異低者。根據上述研究結果，對個案醫院的建議為：（1）強化社區醫療功能、（2）資源配置以加強及突顯病患所認知的重要指標為優先、（3）優先將資源配置到病患所重視的服務品質項目。並建議後續研究者可以嘗試研究其他不同屬性的醫院並比較其與國軍醫院在病患忠誠度的影響因素上有何異同。

Due to the change of time and environment and the reduction of the national defense budget, the military hospitals have to trim the organization or merge with other hospitals in order to adapt to the present policy of the national defense. Therefore, for ongoing existence, military hospitals must strive to raise the perceived satisfaction level of the patients towards organization change and service quality of hospitals to enhance loyalty. This research is a cross-section questionnaire surveying the merging of Tri-Service General Hospital (a medical center) with Keelung Armed Forces General Hospital (a community hospital). The focus is on the connection between patients’ perception of organization change and perceived service quality and the loyalty towards the hospital one year after merging, from November 1982 to October 1983. The goals aim to identify key elements affecting the loyalty of seeking medical service and provide relevant hospitals with positive strategic proposals and corresponding measures in order to stimulate and enhance the patients’ loyalty. The original sample population includes 4,428 people. Among them, 1,720 are with complete addresses. This group is the target of investigation, 38.8% of the original population; surveys were then mailed. Later, 436 questionnaires, 26.9% response rate, were received with valid rate of 100%. Through bivariate statistical analysis, the results show that the following constructs are significantly related with loyalty: “patients’ occupation,” ”having the experience of seeking medical service from other hospitals,” “the state of patients’ perception of organization change,” “the expected service quality of the patients towards the hospital after the organization change,” and “the actual perceived service quality.” Meanwhile, regarding the satisfaction level of the perceived difference between expectation and reality of the service quality, service constructs such as the “tangibility,” “reliability,” “empathy” and “integration” are also significantly related to the loyalty of seeking medical service.Further stepwise regression analysis results show that the key factors influencing the loyalty of seeking medical service include (1) people whose occupations are students, housekeepers, retired or unemployed, (2) people who believe the services of the hospital underwent organization change will be better, (3) people who are perceptionally satisfied with the tangible service quality provided, (4) people who have higher expectation towards the service quality of the reactional services of the hospital, (5) people who are satisfied with the actual perception of the guaranteed service quality of the hospital, (6) people who are satisfied with the actual perception of empathic service quality of the hospital, and (7) people who have low level of perception regarding the difference between the expected and the actual service reliability.According to the results of the research mentioned above, suggestions to the hospital include (1) reinforcing the functions of community medical services, (2) allocating resources to reinforce and increase the visibility of the main indicators perceived and prioritized by the patients, and (3) prioritize the allocation of resources according to the service items emphasized by the patients. Moreover, follow-up researches are suggested to place their emphasis on investigating other hospitals that are different from military hospitals and comparing different factors that are affecting loyalty and their similarities and differences.