醫院能力與競爭策略對醫院績效影響之研究

Abstract

背景︰台灣政策環境快速的變化。核心能力和策略規劃可以使醫院更有效的回應外部環境。只有少數的研究在調查台灣一般急性醫院的5種醫院能力（醫療技術、醫療設備、創新、社區導向和資訊技術能力）及採取的競爭策略，及醫院能力、競爭策略和醫院績效間的關係。 目的︰本研究的目的是去評估台灣醫院能力和競爭策略對醫院績效的影響。 設計�方法︰本研究採問卷調查。它包含問卷的發展及假說的驗證。本研究結合初級問卷調查及次級資料，初級問調查主要集中在醫院的5種能力，而次級資料主要在收集醫院競爭策略和醫院績效的資料。問卷調查對象以409家地區級上之醫院院長、副院長或企劃室主任，回收率為27.5%。競爭策略是以專科異質性和非例行性住院天數比的2個構面進行集群分析。首先，本研究使用層級分析法(AHP)去確定這些關鍵醫院能力的相對權重和優先順序。接下來，同時控制醫院的規模、層級別、權屬別和疾病嚴重度後，以迴歸分析檢驗醫院能力、競爭策略和不同績效間的關係。 發現︰首先，研究結果顯示醫院能力的重要性順序如下︰醫療技術能力、醫療設備能力、創新能力、社區導向能力和資訊技術能力。然後，在不同醫院層級，這些關鍵醫院能力的相對權重和重要性的順序是不同的。第二，醫院能力和競爭策略會影響醫院績效。此外，醫院能力和競爭策略對醫院績效有正向影響。這表示醫院能力和競爭策略是卓越醫院績效的先決條件。 研究限制�含義︰本研究限制是在資料收集上。如果提高樣本回收率，也就是有更大的樣本下將使統計分析得到更確定的結果。 創見�價值︰本研究將有助於醫院，策略管理和資源基礎論的文獻。整合了台灣醫療業這個新的領域。同樣的，本研究有助於實務上的應用，即有助於醫院管理者去了解他們醫院獨特能力和競爭策略的影響。

Background: The policy in Taiwan is rapidly changing. The core competence and strategic planning may enable hospitals to respond more effectively to changes in their external environment. The little evidence exists on the extent to which acute hospitals in Taiwan develop different five hospital competences (medical technology, medical equipment, innovation, community orientation and information technology (IT) competence) and adopt different competitive strategies and the relationship among competences, strategic decision-making and hospital performance. Purpose: This paper aims to assess the influence of hospital competences and competitive strategies on the hospital performance relationship among Taiwan hospital. Design/Methodology/approach: The paper consists of a quantitative survey. It involves mainly the development of instrument and testing of the hypotheses. Primary survey data on hospital competences were combined with secondary data on hospital competitive strategy and performance. The questionnaires were sent to superintendent, deputy superintendent and office of planning’s managers of 409 hospitals accredited as district hospitals and above. The valid return rate was 27.5%. Measures of competitive strategies were developed using cluster analysis based on the two dimensions of specialist’s heterogeneous and non-routine patient days (%). First, this study using Analytic Hierarchy Process (AHP) was carried out to find the relative weights and priorities of these critical hospital competences. Next, Regression analysis examined the relationship between hospital competencess, competitive strategy and various measures of hospital performance while controlling for bed size, accreditation levels, ownership and case mixed index. Findings: First, the results of the study indicate that the critical hospital competences in the order of importance are as follows: medical technological competences, medical equipment competences, innovation competences, community-orientation competences and IT competences. Then, the relative weight and priorities of these critical hospital competences is unlike in the different hospital accreditation levels. Second, hospital competences and competitive strategies are found to influence hospitals’ performance. Moreover, there are positive relationships among hospital competences, competitive strategy and hospital performance. This suggests a need to align hospital competences and competitive strategies as a precondition for superior performance. Research limitations/implications: The paper has limitations as a result of data collection. A somewhat larger sample would obviously permit firmer conclusions to be drawn from the results of the statistical analysis. Originality/value: This paper will contribute to the literature on hospitals, strategic management and resource-based theory. This integration of scope is particularly new to the context of the Taiwan hospital industry. Similarly, this research will have implications for practice. The research findings help hospital managers to understand the impact of the unique competences of their enterprises and competitive strategy.