以個人學習為基礎分析組織學習差異: 內視鏡膽囊切除手術與癌症切除手術之比較

Abstract

學習效果常以多樣的型式存在於個別單位、群體及組織之間。然而，在過去探討組織學習的文獻中，多數研究將組織學習視為個別學習行為的加總，只看整個組織的學習效果，也就是假設個別單位(即個人)不具學習差異下檢視組織學習效果。再者，組織績效的改善或其學習的效果可能源自於許多因素，例如個人的學習、技術進步、以及其他一些內部與環境的因素，如果想對組織學習做更深入的瞭解，便需將這些因素納入考量。 所以本研究嘗試打破以往傳統的作法，不僅考慮整個組織，也探討組織內個別單位的學習，簡單來說就是檢視組織內部的個別學習，再進一步看組織整體的學習效果，同時考慮組織之間以及組織內部的異質性。再者，由於該我國中央健保局之資料庫的完整性以及所具代表性，正好符合實證上的需求。故採用內視鏡膽囊切除手術及癌症切除手術為實證研究對象，探討其是否存在醫師及醫院的學習效果。 首先，本研究採用Hyperbolic模型估計出組織內每位醫師的學習係數，再以非參數法Kolmogorov-Smirnov檢定與Fligner-Policello檢定檢視組織間或組織內部是否存在顯著的學習異質性，最後以三度空間圖示顯示，依不同醫師資歷、醫院權屬別、醫院地區別等因素，來探討其是否影響著組織的學習。 就本研究結果發現，只有在內視鏡膽囊切除手術下的資淺醫師較具有學習的效果，符合一般所說的邊做邊學現象。而醫院位於不同地區及權屬別不同對醫師整體的學習效果並未造成太大差異。另外，在內視鏡膽囊切除手術可觀察到資淺醫師在北部醫院的學習效果較南部醫院好，而資深醫師則在南部醫院的學習效果較北部醫院好。最後，本研究針對實證結果，給予醫師們、醫療院所及相關主管單位一些合理的解釋及建設性的建議作結。

Learning heterogeneity exists between individual learners. However , most past literature views the organization as a population of individual learners, and organizational learning as the sum of individual’s behavior. In other words, organization learning effects were examined assuming the absence of individual learning heterogeneity. Since the improvement of organizational performance or the effect learning may result from many factors such as individual ability, technological improvement and other internal and environmental forces, to understand organization learning, we need to take into account these factors. This study attempts perform an the individual-based evaluation of organizational learning . By doing so , we took into account of the heterogeneity between and within an organization. Based on Taiwan’s National Health Insurance Research (NHIR) database, this study uses the proposed method to examine the impact of learning on the performance of Laparoscopic Cholecystectomy (LC) and cancerectomy surgeries. First, we applies the hyperbolic model to estimate all surgeon’s learning coefficient. Second, we use the nonparametric test, both Kolmogorov-Smirnov test and Fligner-Policello test, to examine the heterogeneity between and within an organization. Finally, learning the heterogeneity is examined using the three-dimension diagrams according to surgeon’s seniority, the location of hospital, and the affiliation of hospital. Our empirical results suggest that junior surgeons have better learning effects than senior surgeons under in terms of performing Laparoscopic Cholecystectomy surgery. However, there does’t exise no differ learning effects for hospital location or affiliation. In addition, for the Laparoscopic Cholecystectomy surgery, we found junior surgeons in the northern hospitals to learn faster. However, senior surgeons in the southern hospitals learn faster than their colleagues in the worth.