醫院的內部責任對員工組織承諾之影響

Internal Responsibility of Hospitals and Employees' Organizational Commitment

目的：在快速變遷且高度競爭的健康照護產業環境中，醫院經營除了績效管理之外，社會責任及利益關係人管理更不可忽視。近年來我國面臨嚴重的醫療勞動人權爭議，本研究旨在探究員工作為醫院的重要利益關係人，看待醫院實踐攸關員工福祉的內部責任之態度及對於組織承諾的影響，對於醫院管理及醫療改革均具有實務意涵。方法：本研究問卷包括員工對於醫院實踐內部責任的感受與期待、醫院實踐社會責任重要性的信念與組織承諾等三個量表，以南台灣某醫療體系員工為研究母群體，在2013年3月至10月間發放600份匿名問卷，完整回收561份，回收率達93.5％。結果：員工對於醫院實踐內部責任的感受與期待確有顯著差距。年齡愈大、職級愈高以及對於醫院實踐內部責任的感受愈佳者之情感性承諾明顯強烈。醫事人員、醫學中心以及醫院實踐社會責任重要性信念較高者之持續性承諾明顯強烈，醫師則相反。職級愈高、實踐內部責任的感受愈佳以及對於醫院實踐社會責任重要性的信念愈強者之規範性承諾明顯強烈。結論：當員工對於醫院實踐內部責任的感受愈是積極正面，對醫院的認同程度就會愈高。若重視員工是醫院的重要的資本，就必須積極提供友善且人性化的工作環境，以提升員工之責任感，進而增進其對組織之承諾。

Objectives: In the fast changing and highly competitive environment of the health care industry, social responsibility and employee commitment cannot be ignored by hospital management in the pursuit of performance. Hospitals in Taiwan are dealing with concerns about the labor rights of medical workers. The aims of this study were to examine employees' perceptions of and expectations about the internal responsibility practices of hospitals and to explore the relationship between those perceptions and their organizational commitment. Methods: The questionnaire developed for this study was composed of three scales: employees' perceptions of and expectation about internal responsibility practices of hospitals, their belief in the importance of the hospital's social responsibility (IHSR) and their organizational commitments. The study population consisted of employees from a medical group in Southern Taiwan. A total of 600 anonymous questionnaires were distributed from March to October 2013; 561 of these were successfully completed, yielding a completion rate of 93.5%. Results: There were significant differences between employees' perceptions of and expectations about hospital's internal responsibility practices. Employees who were senior, had higher level jobs and had greater perceptions of internal responsibility practices exhibited a stronger affective commitment. Employees who were medical support staff, worked in a medical center and believed in the importance of a hospital's social responsibility displayed stronger continuance commitments, where as physicians did not have such commitments. Employees who had higher level jobs, greater perceptions of internal responsibility practices and stronger beliefs in IHSR exhibited stronger commitments. Conclusions: When employees had more positive perceptions about the internal responsibility practices of the hospital where they served, they had higher levels of identification with the hospital; this influenced job satisfaction and organizational performance. Employees should be recognized as crucial capital by hospitals and managers must provide them with friendly and humane work environments in order to promote a greater sense of responsibility and organizational commitment.