組織轉型與策略核心組織之建構：台大醫院雲林分院個案研究

Abstract

組織轉型是一項富挑戰性且不容易成功的工作，方向感的確立、向心力的凝聚及使命目標的達成，均有賴有效的領導及好的管理工具之運用。在這高度競爭且變化多端的環境下，一個組織要永續生存且又能達成其使命，除了要精通經營手法外，更要能讓組織內上下同仁達成共識，有一致性的溝通語言，有共同願景、價值觀，且又能全力以赴才能成功。醫療產業屬管制性的行業，受國際化的衝擊較小，但因人口老化、科技進步及生活水準提高等帶動的醫療服務品質期望提高、醫療人力的繼續投入及新醫院的開張等，導致所需費用的增加一般都高過國內生產毛額 (GDP) 的成長。全民健保於十一年前開辦，近年來持續頻臨破產邊緣，醫院總額支付制度的實施雖讓健保局壓力稍減，卻因規劃的每年醫療費用的成長率不足，又缺乏良好的協調制度，醫療機構提供的服務支出遠超過醫院總額的給付，健保局乃以加重核減輔以浮動點值來控制給付之費用，各醫院苦不堪言，所採取的一些因應限縮措施又馬上遭致民眾反感及健保局的干預，進退兩難。 雲林縣長期醫療資源缺乏，民眾健康情形欠佳，地方乃要求台大前來設校及設院。原署立雲林醫院於民國93年4月改制為台大醫院雲林分院之後，8月本人奉派擔任院長。因原署立雲林醫院體質不佳，人才及設備不足，需要大量注入新血，再加上改制後文化融合及制度統一等問題均極複雜，的確需要樹立一個努力方向，加上大量投資、極力整頓及確立目標才能達成。 平衡計分卡、策略地圖的概念由Kaplan 及Norton在1990年以後陸續提出，不僅強調績效的評估要在財務、顧客、流程、學習與成長四個構面間達到平衡，更進而把它當成策略管理及組織溝通的工具，非常符合雲林分院的需要，另外，再參考馬偕醫院推動平衡計分卡的經驗以及本人上課所學到的策略管理和其他管理知識，便以讀書會的方式開始，由本人親自推動，一步一步從建構使命及願景開始，加上內外部環境分析之後，初步形成策略主軸及各構面的策略目標，至此院層面的策略地圖得以完成。接下來決定衡量指標、現值及目標值、行動方案、負責單位，而形成院層面的平衡計分卡。各單位隨即針對院層面的策略地圖及平衡計分卡發展各單位之策略地圖及平衡計分卡，並確實推動各項行動方案。有關的概念及推動情形除了透過各式管理會議、座談會及院訊宣導外，並舉行一年二次的經營策略管理會議，三月份會議在檢討過去一年實施成果並修正策略地圖及平衡計分卡，九月份會議則在規劃明、後年之目標、行動方案及預算，並修正策略地圖及平衡計分卡。至此，本院建構策略核心組織的藍圖大致成形。 在不到二年的時間內，以上措施均陸續完成，四個構面的成果也算豐碩，願景的達成也愈來愈接近。由於本計畫是由院長親自漸進推動，採平行組織方式，且不急於與績效掛勾，阻力算是較少，初步而言算是成功的，當然有更多的事情要繼續去推動及落實，讓本變革方案能深植人心，成為制度及文化。本研究所面臨或探討的關鍵成功要素及推動的障礙，也提供後續有意推動類似計畫者之參考。此外，本研究成果亦可作為政府推動公立醫院多元化經營之參考，也可以作為其他組織進行轉型時之借鏡。

Organizational transformation is a challenging and difficult job. Effective leadership and good management tool are required for direction, team build-up and goal achievement. Under this highly competitively and variably environment, in order for an organization to survive and to achieve its mission, the leader not only must master the management but also must provide common language, vision and value to motivate people. Although healthcare industry is protected by government and less influenced by globalization, but its expense far exceed the Gross Domestic Product (GDP) due to aging of population, progress of technology, increasing expectation of people, continuous supply of medical professionals and opening of new hospitals. Our National Health Insurance (NHI) started 11 years ago, but faced financial difficulties in recent years. Under the Hospital Global Budget system, NHI shifted its tension to the hospital by critical audit and floating value of payment to control the budget disregarding how many services provided by hospital. All hospitals suffered the dilemma without good solution. The medical supply in Yun-Lin County has been less under adequacy. The general health of the people is also ranked the last in whole Island. National Taiwan University was asked to set-up branch in both school and hospital. After National Taiwan University Hospital merged and acquired the Yun-Lin Hospital, the Department of Health, at April, 2004 to become its Yun-Lin branch, the people increased the expectation to this hospital greatly. But due to inadequate manpower, facility, and problems in cultural conglomeration, system and rule setup, the hospital required clear direction, vast investment and synchronized devotion from all staffs. Balanced scorecard (BSC) and strategy map initiated by Kaplan and Norton since 1990 not only emphasized the idea of balance among finance, customer, process and growth and development perspectives, but also became a good tool for strategy management and communication. It met our situation and requirement. After learning the experiences from McKay Memorial Hospital in promoting the BSC and strategy map, and also lessons from executive MBA classes, we started to establish the strategy-focused organization in our hospital step by step, first by book reading of all staffs leaded and motivated by Superintendent. Following the vision establishment and analysis of the external and internal environments, the strategy and strategic goals were decided. The strategy map of whole hospital was then built. After we decided the measurement indicators, their value and goals, initiatives and responsible departments, BSC of the whole hospital was also built. Each department was asked to build their strategy map and BSC in association with hospital’s one and executed their initiatives hardly. Besides promoting the action in every meetings and publications, we held two main strategic management meetings each year. First one in March focused on evaluation of the results of previous year, while second one in September focused on planning for the coming two years. Strategy map and BSC were modified if necessary. In less then two years period, the above actions are accomplished smoothly. We also achieve fairly good results and are approaching our vision. The features of our project are following: leading by Superintendent, gradual action thru same organizational structure, no linkage with performance evaluation initially and hence less resistance. After initial success, much still have to be done for the change be well-established and culture been embedded in every member of hospital. The key successful factors and obstacles to be avoided can also provide good reference for those who plan to execute the similar project. The experience gained from this study can also provide good reference for government which is promoting organizational change in public hospitals and other organization which is undergoing transformation.