台灣醫療產業的組織合作：不對等合作關係不作等合作關係

在一個組織位階結構制度化的醫療產業中，權力與地位不平等的組織進行合作如何可能？本論文分析地位不對等的醫療組織對合作關係正面評價的影響因素。以自行設計之結構式問卷進行資設計集，構以深入進行，以地集教學醫深入訪以上之128家醫深為研究對象，回收89家醫深問卷，回收率，深入進行家醫深主管，成功率55.1%。89家醫深共提出345對實質互動的合作關係。分析結果指出，擁有合作決策主導權，以及透過間接第三者推薦，都增加優勢組織對合作關係的認可，顯示權力支配原則是優勢組織管理不對等合作關係的重要基礎。不對等合作關係中的兩方對合作正面評價的影響因素不同，反映合作雙方在產業結構中強、弱不同的權力位階關係。研究結果支持了制度論者所提出組織行動是鑲嵌在制度環境中的權力關係與價值架構的論點，也對「社會鑲嵌」論述中有關第三者的策略性位置提供了部分證據。

The central question of this paper concerns the possibility of cooperation between and among health service organizations that operate within the confines of extreme institutional stratification. To determine the grounds for partnership success, and to identify the benefits and barriers associated with these partnerships, we examined human resource transfers (n=345) at 89 hospitals. Data collected via questionnaires and interviews indicate that a) dominant organizations feel it is important to gain leadership positions in order to express positive evaluations of asymmetric cooperation, and b) successful instances of cooperation are generally established through social relationships --i.e., third-party recommendations. The concept of fairness in such exchanges has different meanings for the asymmetric partners, with symbolic gains often considered more important than financial gains. We suggest that future research in this area requires a strong focus on hospital stratification.