病患忠誠度之研究：探討對機構、醫師及護理師滿意感之影響

The Determinants of Patient Loyalty: Exploring the Impact of Institutions, Physician, and Nurse Satisfaction

病患忠誠度是關乎醫院診所長期存活的關鍵，過去的關係行銷研究忽略了顧客與第一線員工間的親近關係對廠商關係可能產生的危害，例如：醫師可能帶走整批的病患；也缺少將員工進一步分成主力與輔助角色，從關係前因、關係中介與調節變項的角度進行研究。本研究將洗腎院所、醫師與護理師分為關係前因、關係滿意中介與結果三組變項，並將關係滿意探究其調節角色，分析其間影響關係。回收210份有效問卷，採用結構方程式（PLS-SEM）進行分析，研究結果為：（1）聲望是洗腎院所的重要前因，有助於增強洗腎者對院所的滿意，進而增強洗腎者對洗腎院所的忠誠；（2）專業性與親和力是醫師的主要關係前因，能夠提高洗腎者對醫師的滿意，部份地增強洗腎者對院所的忠誠；（3）傾聽與照護能力是護理師的關鍵前因，增強洗腎者對護理師的滿意，但無法提升洗腎者對院所的忠誠；（4）關係滿意的中介效果上，護理師滿意無法中介影響院所忠誠，但能夠透過對院所與醫師滿意的中介效果與前因變項產生影響。研究意涵建議醫療服務廠商善用顧客、廠商與員工關係前因─中介─結果的架構，可有助提升顧客、員工與廠商三者的關係結果。 The increasingly aging society and declining birth rate caused the family member with labor power to leave home for work, but leaving the care-needed elderly at home. This not only caused the dilemma of requiring home-based caregiving, but also affects the quality of life between family members. This article propose the use of local community resources with modern information and Communication Technologies to construct a comprehensive caregivers support service system in order to achieve innovative in place day-care centers on cloud health care model. The employ of wearable devices 24/7 non-stop monitor on personnel's physiological and mental status, and possible danger detection, thus enhancing the capabilities on caregiving during day and night. The research explored existing literature and utilized qualitative focus group interviews, the validity verification utilized expert validity and triangulation The lists of experts were generated through snowball approach of recommendations from academic, followed by purposive sampling where experts and academics of the relevant field were invited to hold talks. These open discussions were recorded to collect information. The results were analyzed on five aspects: 1) availability, 2) accessibility, 3) accommodation, 4) affordability and 5) acceptability. All the view and opinions collected from the expert discussions were analyzed and collated. The conclusions were as follows: cloud platforms and wearable devices has high exploitability; community schools meets the accessibility criteria; health caregiving, day-to-day services and emergency management fulfils accommodation; the average family users shall pay for these services, while low income families shall be subsidize by government to eliminate the affordability issues; Experts generally believe that this model is highly acceptable. A recommendation regarding the confidentiality of personal information when using cloud health care services should also be examined. The results of this research can be used as a reference for the government's planning of long-term care policies.