醫院策略型態與績效評估指標之現況及其相關性研究－以平衡計分
卡觀點分析
Hospital Strategic Typology and Performance Evaluation Indicators
－From the Perspectives of the Balanced Scorecard
中文摘要
近年來，健保財務緊縮，加上合理門診量及總額預算的實施，使得醫療環境的大 幅變化，醫院間競爭也更加劇烈。醫院管理者如何有效地評估本身能力和尋求適 宜的競爭策略，是其面臨的重要課題。醫院採取的策略型態會影響到其運作，包 括績效衡量和評估系統的設計等。傳統上多以財務面的結果來代表經營績效，常 因此忽略能讓醫院永續經營的動力。因此，Kaplan & Norton 於 1990 年提出「平
衡計分卡」的概念，除了「財務面」外，也重視「顧客面」、「企業內部流程面」
和「學習與成長面」等非財務指標，並將組織的使命和策略整合為一套全方位的 績效評量架構。
本研究結合 Miles & Snow 於 1978 年提出的四種策略型態與平衡計分卡之概念，
以結構性問卷作為測量工具，對於台灣地區 126 家地區教學級以上醫院所採取的 策略型態及其對績效評估指標看法予以分析探討。回收之有效問卷共 70 份（回 收率為 55.6%），而使用之統計分析方法包括卡方檢定、皮爾森積差相關、單因 子變異數分析及 Tukey＇s 事後檢定等。
研究結果顯示，地區教學級以上醫院採用分析者策略者佔最多數（51.4%），其次
是採取前瞻者策略的醫院（佔 18.6%），再其次為採取防禦者策略的醫院（佔 15.7%），最少數的則為採取反應者策略的醫院（佔 14.3%）。醫院採取的策略型 態會影響其對顧客、內部流程及學習與成長構面等指標資料取得方便性上的看 法，而採取防禦者策略的醫院相較於採取其他三項策略型態的醫院而言，認為在 上述三類構面之指標資料取得上較不方便。
因此，本研究提出下述建議：一、建議衛生主管機關能在參考平衡計分卡的概念，
以建立一套更全面性的醫院評鑑標準；二、建議醫院管理者在設計績效評估指標 時，必須與本身策略進行聯結，才能更有效地管控醫院營運狀況，且應更注重顧 客及學習與成長構面指標的衡量。三、建議後續研究者，可採縱貫面方式以進一 步瞭解環境的變遷對醫院策略取向上的影響程度。
英文摘要
In recent years, due to financial pressure from the National Health Insurance and the implementation of the Global budget payment system, the competition among hospitals increase drastically. How to precisely evaluate hospital’s ability and adopt
suitable management strategies became an important issue facing hospital administrators. The balanced scorecard presented by Kaplan and Norton in 1990 provides a framework for managing strategy that translates organizational visions and strategies into four dimensions of performance evaluations: financial, customer, internal business process, and learning and growth.
The purpose of this research was to explore the relationship between the strategic typology of hospitals and their perspectives of performance evaluation indicators. We used a structured questionnaire to survey hospitals administrators of medical centers, regional hospitals, and district teaching hospitals in Taiwan, 126 in total. In the end, 70 valid questionnaires (a response rate of 55.6%) were obtained. Chi-square test, Pearson correlation, ANOVA, and Tukey’s test were used to analyze the data.
Results showed that 51.4% of the sample hospitals adopted the analyzer strategy, followed by the prospector strategy (18.6%), the defender strategy (15.7%), and then the reactor strategy (14.3%). Strategic typology had significantly influenced hospital administrators’ viewpoints on the availability of data in three dimensions: customers, internal business process, and learning and growth. Hospitals who adopted the
defender strategy considered that it was difficult to collect data in the aforementioned three dimensions.
There were three suggestions: first, Department of Health may apply the concepts of the balanced scorecard on the hospital accreditation. Second, hospital administrators should pay more attention to the performance evaluation indicators with respect to customers and learning and growth. Additionally, when designing performance evaluation indicators, hospital administrators need to associate them with their strategies. Third, future researchers may use a longitudinal study design to study the impact of changing healthcare environment on hospital strategies.
