修正動機模式探討醫療知識庫系統之行為意圖－－技術社會動機的觀點

An Extension of the Motivation Model to Explore the Behavioral Intention of Health Knowledge Repository Systems: Technological-Social-Motivational Perspectives

近來在台灣的醫療產業，由於外在競爭壓力與健保給付的緊縮，以及健康知識的普及，使得醫療院所必須在以病人為中心的前提下，提高醫療品質與降低醫療成本。然而，醫護人員的高離職率與醫院評鑑的高頻次，使得高知識密集的醫院，必須面臨知識資產的妥適管理，方得以生存於超競爭的醫療環境中。此時，知識管理乃應運而生，台灣的醫療院所也越來越多經營者開始使用知識管理系統或知識庫系統來管理組織的知識資產。 本研究以Davis et al.（1992）所提出的動機模式為基礎，納入技術因素與社會因素等觀點，整合後提出「醫療知識庫系統行為意圖」之技術社會動機因果模式，並經過驗證性因素分析與結構方程模式之驗證。研究結果發現：（1）組織支持能直接正向的影響技術因素與信任因素。（2）技術因素與信任因素能直接正向的影響系統的有用性認知、主觀規範與愉悅性認知。（3）有用性認知、主觀規範與愉悅性認知能直接正向的影響系統的行為意圖。（4）主觀規範能直接正向的影響有用性認知與愉悅性認知。（5）在直接效果方面，影響醫療知識庫系統行為意圖最大者為最大者為主觀規範，其次為愉悅性認知，最後為有用性認知。而直接影響有用性認知、主觀規範、愉悅性認知最大者為信任因素。（6）在總效果方面，影響行為意圖之總效果最大者為信任因素，其次為組織支持。（7）值得注意的是：組織支持必須間接透過技術因素與信任因素以影響主觀規範，換句話說，技術因素與信任因素在組織支持與主觀規範之間具有完全中介的效果。本研究之發現，可做為未來研究之理論基礎，亦可提供醫院的經營者及管理者在引進醫療知識庫系統時，作為實務推動之參考。

Recently, due to the outside competitive pressure and the constringent policy of health care payment along with the diffusion of health knowledge, has made the medical institutions and hospitals in Taiwan have to enhance the medical quality and to lower the medical cost on the premise that the patients are on the top priority. However, the high resignation rate of the doctors and paramedics as well as the high frequency of the hospital accreditation have made the hospitals, which are knowledge-intense organizations, forced to properly manage the knowledge assets in order to survive in the super-competitive environment of medical care. In the meantime, knowledge management comes out with this trend. More and more executives of the medical institutions and hospitals in Taiwan also start using the knowledge management systems or knowledge repository systems to manage the knowledge assets of the organizations. Based on Davis et al. (1992)'s motivation model, the purpose of the present study is to integrate technological factors and social factors to explore the behavioral intention of health knowledge repository systems. A framework of health knowledge repository systems´ behavioral intention model was proposed and verified by Structural Equation Modeling (SEM). Our findings showed that (1) Organizational support has significantly positive effect on technological factors and trust factors. (2) Technological factors and trust factors jointly have significantly positive effect on perceived usefulness, subjective norm, and perceived enjoyment. (3) Perceived usefulness, subjective norm, and perceived enjoyment jointly have significantly positive effect on behavioral intention. (4) Subjective norm has significantly positive effect on perceived usefulness and perceived enjoyment. (5) According to the comparison of the direct effects of all constructs, the rank of direct effect on behavioral intention is subjective norm, perceived enjoyment, and perceived usefulness. Meanwhile, trust factors have the greatest effect on perceived usefulness, subjective norm, and perceived enjoyment. (6) According to the comparison of total effects of all constructs, the rank of total effect on behavioral intention is trust factors, and organizational support. (7) Organizational support has indirect effect on subjective norm via technological factors and trust factors. The findings may be used as theoretical base for future research and can also offer empirical foresight to executives and managers of hospitals when they initially introduce the health knowledge repository systems into their organizations.