以組織變革導入創新醫院設計－以某醫院急診室改建專案為例

Abstract

藉由醫療產業分析可以得知「醫療服務使用量增加」及「醫療人員負擔增加」是台灣醫療正在面臨的重要議題，面對這些議題，科技的導入並不能有效且根本地解決問題，而是必須從整個醫療體系的文化、流程開始思考醫療的本質，滿足所有利害關係人的需求及最大利益。 此導入創新醫院設計的改建案不單只牽涉室內空間的安排規畫，更涉及了醫護人員對於醫療本質的認知與態度，是一場關於溝通說服的組織變革。此改建案的負責人藉由尋求外部顧問共同執行前期研究，不同於以往改建的方式，必須藉由溝通與說服才能夠讓底下的急診同仁認同及參與，在規劃急診空間的過程中，他們從根本開始思考醫療的本質與核心，藉此重塑急診室的願景、文化。 本研究站在管理顧問的角色以此個案為核心，藉由撰寫個案重現變革發生的現場，接著讓理論與實務相互對話，從研究個案內容中學習理行並進的精神。研究發現雙人核心團隊經歷了「理」、「情」、「行」的溝通說服循環過程，在三個構面中可看見W主任逐漸建立對此團隊的信任。 在雙人核心團隊取得共識後，以Lewin變革三階段及Kotter變革八階段解析其變革過程，在過程中，雙人核心團隊利用「準備舞台」、「定調開場」、「控制節奏」及「推進劇情」這四個溝通策略讓變革劇情能順利推進，最後歸納出變革成功的關鍵因子包含價值陳述、資源投入與核心團隊。

According to the analysis of medical industry, 'the increase on medical utilization' and 'the increase on workload of medical staff' are big challenges facing the medical industry in Taiwan. To tackle the issues effectively, medical culture and service process building on core values of medicine need to be re-designed, supplemented with new technologies, to maximize stakeholders’ benefits. The organizational change through communication and persuasion underlying the W Hospital Emergency Room reconstruction by implementing innovative hospital design is a potent case in point. The project leader brought in a capable external consulting agent to conduct early-stage research on the space and route designing on site. The case demonstrated that only through involving the staff, communication and persuasion could bear fruits. During the process, the fundamental medical values were consolidated and consensus was built for the new vision and culture of innovation and openness. From the vantage point of a management consultant, the process of communication and persuasion were unraveled through applying the theories to the case. Emphasizing 'cognition', 'affect' and 'behavior' respectively, Director W’s trust on the co-leader and the team was established through the circle of persuasion. The researcher applies Lewin’s 3 step model and Kotter’s 8 step model to analyze the changing process. During the process, the team co-leaders have a coherent strategy for persuasion including 'setting the stage', 'creating the frame', ' managing the mood' and ' reinforcing good habits ' to make changes happen. Finally, key success factors in organizational change including 'endorsement', 'resources' and 'team' are discovered.