運用競值途徑於醫院護理部門組織文化領導型態與組織效能關係之
研究
The application of competing values approach to the relationships in organizational culture, leadership styles and organizational
effectiveness in the nursing department of hospitals
中文摘要
本研究的目的是：一、瞭解護理人員之基本特性與醫院護理部門的組織文化及組 織效能間的關係。二、瞭解護理主任、護理長之基本特性與領導型態間的關係。
三、瞭解護理主管自評領導型態與部屬評護理主管之領導型態是否相同。四、瞭 解護理部門的組織文化、領導型態與組織效能間是否相關。五、瞭解各醫院護理 部門之組織文化、領導型態與組織效能的競值類型。六、瞭解醫學中心、區域醫 院與地區醫院之護理部門的組織文化、領導型態與組織效能之契合狀態。綜合研 究結果提出具體建議，以為提昇醫院護理部門組織效能之參考。
本研究參考多位學者所使用之競值途徑理論評量工具與問卷修編而成的結構式 問卷表為研究工具；研究對象為台北市內、且經行政院衛生署八十五至八十七年 醫院評鑑及教學醫院評鑑為醫學中心、區域醫院與地區醫院之護理人員，本研究 共發出 1993 份，回收之有效問卷 1794 份（有效問卷回收率 90.01%）。
研究結果發現：一、護理人員之基本特性與醫院護理部門的組織文化有顯著相 關。二、護理主任、護理長之基本特性與自評領導型態均無顯著差異。三、護理 主管之自評之領導型態得分，均明顯高於部屬評護理主管之領導型態得分。四、
護理人員之基本特性與醫院護理部門的組織效能有顯著相關。五、醫院護理部門 之組織文化、領導型態與組織效能三者間有顯著相關。六、醫學中心、區域醫院 及地區醫院之護理部門的組織文化及組織效能有顯著差異。七、醫學中心、區域 醫院及地區醫院之護理部門的領導型態未有顯著差異。八、在競值途徑下，三家 醫學中心之護理部門的組織文化、領導型態及組織效能之契合狀態均為部分趨同 部分趨異；區域醫院十一家中，有四家呈現高度趨同、其餘七家呈現部分趨同部 分趨異；地區醫院十四家中，有一家呈現高度趨同、二家呈現高度趨異、其餘十 一家呈現部分趨同部分趨異。
上述之研究發現可提供護理管理者之參考。同時建議：1、護理行政者，要了解 自己部門的組織文化、並營造護理部門整體性的組織文化；護理領導者要了解自 己的領導型態，適當調整、配合或塑造組織文化，以提昇組織效能；加強各層護 理主管與部屬之溝通；適當採行留任措施，降低流動率。2、在護理教育方面，
要加強新進人員之職前訓練，協助員工適應整個社會化過程。3、對未來之研究 方面，能做深入訪談；長期追蹤；擴及台北市外之教學醫院；並可增加其他變項 來探討。
英文摘要
The purpose of this study is (1) to understand the basic characteristics of nursing staff and the relationship between organizational culture and effectiveness in the nursing departments of the hospitals; (2) to understand the relationship between the basic characteristics and leadership styles of nursing directors and head nurses ; (3) to understand the sameness of leadership styles of nurse’s boss between the
self-evaluated ones and the ones evaluated by the subordinates; (4) to understand the correlation among organizational culture, leadership style, and organizational
effectiveness in the nursing departments; (5) to understand the types of competing values in organizational culture, leadership style, and organizational effectiveness in the nursing departments of the hospital; (6) to understand the consistency status of organizational culture, leadership style, and organizational effectiveness in the nursing departments of medical centers, regional hospitals and local hospitals.
Recommendations will be proposed according to the results of the study for the reference of promoting the organizational effectiveness in the nursing departments of the hospitals.
The tool of this study is a revised structured questionnaire used by many experts as an evaluation method of competing value approach. The study group is composed of 1,993 members of nursing staff in the medical centers, regional hospitals , and local hospitals assessed by Department of Health , Executive Yuan from 1996 to 1998 in Taipei. 1,794 valid questionnaires were answered and returned (valid response rate:
90.01%)
The study found(1) significant correlation between basic characteristics of nursing staff and organizational culture in the nursing departments of the hospitals ; (2) no significant difference between basic characteristics and the self-evaluated leadership styles in nursing directors and head nurses; (3) the score of self- evaluated leadership styles by the nurse’s boss is significantly higher than the score of leadership styles evaluated by subordinates; (4) significant correlation between basic characteristics of nursing staff and organizational effectiveness in the nursing departments of the hospitals ; (5) significant correlation among organizational culture, leadership style, and organizational effectiveness in the nursing departments of the hospitals ; (6) significant difference in organizational culture and effectiveness among the nursing departments of the medical centers , regional hospitals and local hospitals ; (7) no significant difference in leadership style among the nursing departments of medical centers, regional hospitals and local hospitals ; (8) in competing value approach, the consistency status of organizational culture, leadership style, and organizational effectiveness in three medical centers are partly toward the sameness and partly
toward the difference; while in eleven regional hospitals, four are highly toward the sameness and the other seven are partly toward the sameness and partly toward the difference, and in the fourteen local hospitals, one is highly toward the sameness, two are highly toward the difference and the other eleven are partly toward the sameness and partly toward the difference.
All the above findings can be served as a reference for nursing managers. The
findings also suggest (1) nursing administrations should understand the organizational culture of the department and establish the total organizational culture of nursing departments; nursing leaders should understand their own leadership styles and properly adjust, compromise, and cultivate to promote organizational effectiveness;
enforce the communication of nursing managers and staff in all levels; take
appropriate procedures to keep nursing staff on job to lower personnel turnover rate;
(2) in nursing education, enhancing the pre-job training is necessary for new staff to assist their process of socialization; (3) in future research, in-depth interview,
long-term follow-up should be performed and the study range should involve teaching hospitals beyond Taipei and other variables should be added for further study.
