預算控制制度對醫院組織效能影響之探討－以角色壓力作為中介變數

Abstract

在醫療專業科層的組織中，擁有權力與影響力的醫療專家們掌控了醫療作業程序，成為組織運作的核心。而醫療專家們從事管理活動主要是透過專業倫理所驅策的自我控制與同儕間的相互調整，因而醫療作業受到專業指揮系統的影響與主導，甚至跨越正式化的行政管理控制系統。因此，當組織強調正式化的行政控制機制時（如預算控制制度），在專業科層組織中擔任管理任務的專家可能會發生角色不相容（角色衝突、角色模糊）的壓力，而負向地影響組織效能。\\r本研究以國內區域級以上醫院為研究對象，透過角色壓力（角色衝突與角色模糊）來探討在不同程度的專業承諾情境下，預算控制制度對於提昇醫院組織效能所能扮演的角色。研究樣本包括10家醫院的303位預算部門主管。研究結果發現：(1)在高專業承諾導向的組織情境中，預算強調對組織效能並未存在直接因果關係，而是預算強調正向影響角色壓力，並透過角色壓力的中介影響效果，進而間接負向影響組織效能。(2)在低專業承諾的情境下，預算強調會對組織效能產生直接正向的影響效果；此外，預算強調亦會透過負向影響角色模糊，才間接影響組織效能。但是預算強調與組織效能間之關聯性，若透過角色模糊中介影響效果的解釋力，則會比直接影響效果的解釋力來的低。

In medical professional bureaucracy organizations, medical professionals are central to the organizational operation. Their behaviors are mainly affected by self-control and mutual coordination. Therefore, medical professionals often perceive role stress when organizations emphasize formal management control and thus it’ll further negatively affect organizational effectiveness. To explore the relationship between budgetary control system and organizational effectiveness under different level of professional commitment orientation, this study applied path analysis to a sample of 303 budgetary managers in ten regional hospitals in Taiwan. Results supported the proposed hypotheses that under high professional commitment, the relationship between budgetary emphasis and organizational effectiveness can be fully mediated by role stress. However, under low professional commitment, the relationship between budgetary emphasis and organizational effectiveness can be accounted for by a partial mediation where budgetary emphasis decrease role ambiguity, and role ambiguity is negatively associated with organizational effectiveness. The explanation ability of indirect effect is higher than the direct effect.