本研究運用高層(upper-echelons)理論探討醫院院長與高階經營團隊關係品質程度、經營團隊信任氣候及管理創新之間的關聯性，同時也檢視經營團隊信任氣候及院長與經營團隊之關係品質差異在上述關聯性上扮演的中介及干擾角色。研究對象為台灣地區之地區醫院層級以上的醫療機構，採用問卷調查法針對144家醫院的504位高階主管的回覆資料進行統計分析。研究結果顯示，院長與經營團隊關係品質程度對經營團隊信任氣候有正向影響，經營團隊信任氣候對管理創新也有正向影響；同時，經營團隊信任氣候對院長與經營團隊關係品質程度及管理創新的關係具有中介效果。最後，與預期相反的是，結果顯示院長與經營團隊之關係品質差異正向干擾院長與經營團隊關係品質對於經營團隊信任的影響。
本研究對理論有下列貢獻。首先，本研究將高層(upper-echelons)理論運用在醫療機構經營管理的探討，擴大了此理論的適用範疇。其次，以往的高層理論研究多忽略CEO的角色，本研究清楚呈現了CEO與TMT社會互動隊組織管理的意涵。最後，以往有關關係品質的研究，主要以企業中較低的管理階層為主，本研究因此也延伸了主管與部屬交換理論(LMX)的運用範疇。研究結果對於醫療機構的經營管理實務，以及後續研究也提供了新的可行方向。
關鍵詞: 高層理論、醫院院長、高階經營團隊、主管與部屬交換關係、信任氣候、管理創新

本研究對理論有下列貢獻。首先，本研究將高層(upper-echelons)理論運用在醫療機構經營管理的探討，擴大了此理論的適用範疇。其次，以往的高層理論研究多忽略CEO的角色，本研究清楚呈現了CEO與TMT社會互動隊組織管理的意涵。最後，以往有關關係品質的研究，主要以企業中較低的管理階層為主，本研究因此也延伸了主管與部屬交換理論(LMX)的運用範疇。研究結果對於醫療機構的經營管理實務，以及後續研究也提供了新的可行方向。

This study employed the upper-echelons to examine the relationships among CEO-top management team (TMT) exchange, TMT trust climate and management innovation in Taiwan's healthcare organizations. The mediating effect of TMT trust climate and the moderating role of CEO-TMT exchange differentiation, respectively, is explored as well. Based on the survey approach, 504 executive responses in 144 hospitals were collected. Analytical results show that CEO-TMT exchange positively affects TMT trust climate, which in turn positively influences management innovation. Moreover, TMT trust climate plays a mediating role between CEO-TMT exchange and management innovation. Finally, CEO-TMT exchange differentiation positively moderates the relationship between CEO-TMT exchange and TMT trust climate, a finding that is different from the expected direction.
The study has several theoretical contributions. First, an examination of the TMT socio-psychometric concerns in hospitals extend the upper-echelons theory, which thus far remains focus on business organizations. Second, by exploring CEO-TMT social dynamics, the study also contributes to the theory, which focuses almost on whole TMT while ignores the unique role CEO. Third, the study also contributes to the leader-member exchange theory (LMX), which focuses almost on lower-level supervisor-subordinate relationships while ignores the upper-echelons executive exchange. Research findings also produce valuable insights for the strategic implications of top management in hospital institutions. Limitations and future directions were discussed as well.
Keywords: upper-echelons theory, CEO-TMT exchange, trust climate, management innovation, healthcare organizations

論文審定書………………………………………………………… i
誌謝………………………………………………………………… ii
中文摘要…………………………………………………… ……... iii
英文摘要………………………………………..………………….. iv
目錄…………………………………………………………….…... v
圖次………………………………………………………………… vii
表次………………………………………………………………… viii
第 一 章 緒論……..……………………………………………….. 1
第一節 究背景與動機………………………………………….. 1
第二節 研究目的……………………………………….………. 4
第三節 研究範圍與研究貢獻………………………………….. 4
第四節 研究流程……………………………………………….. 6
第 二 章 文獻探討……………………………………….……....... 7
第一節 醫療機構與其領導者……………..…………………… 7
第二節 高層理論與高階經營團隊…………………………….. 10
第三節 主管與部屬交換關係……………………………….…. 11
第四節 經營團隊信任氣候…………………………………….. 13
第五節 管理創新……………………………………………….. 15
第六節 研究假說……………………………………………….. 18
第 三 章 研究方法………………………………………………… 21
第一節 研究架構……………………………………….……… 21
第二節 研究樣本……………………………………………… 22
第三節 樣本之描述性統計分析……………………………… 22
第四節 變數操作型定義與衡量方式………………………… 25
第五節 統計分析方法………………………………………… 29
第 四 章 研究結果………………………………………………..… 32
第一節 資料加總正當性評估………………………...………… 32
第二節 相關分析…………...…………………………………… 32
第三節 層級?歸分析..………………..………………..…….… 34
第 五 章 結論與建議..………..………..………..……….…..……… 40
第一節 研究意涵…..………..………..………..………..………. 40
第二節 研究限制與未來研究方向…..………..…………...…… 44
參考文獻……………....………..………..………..………..…...…….. 46








圖 次
圖1-1研究流程………………………….…………………………….. 6
圖3-1研究架構圖……………………………….…...………...……… 21
圖4-1院長與經營團隊關係差異與團隊信任氣候之二階交互作….. 43






























表 次
表3-1醫療機構背景分析……………………………………...……… 23
表3-2高階經營團隊背景分析……………………………………..… 24
表3-3 受訪者背景分析…………………………………………...…. 24
表3-4院長與經營團隊關係品質的問項內容……………………..… 26
表3-5團隊信任氣候的問項內容…………………………………..… 27
表3-6管理創新的問項內容…………..……………………………… 28
表4-1資料加總正當性評估………………………………………..… 32
表4-2研究變數之相關分析摘要表………………………………..… 33
表4-3醫院院長與經營團隊關係品質與團隊信任氣候之迴歸分析... 34
表4-4團隊信任氣候與管理創新之迴歸分析……………...………… 35
表4-5團隊信任氣候對院長與經營團隊關係品質與管理創新的中
介效果分析………………………………….………………………… 36
表4-6院長與經營團隊關係品質差異對院長與經營團隊關係品質
與團隊信任氣候之迴歸分析………………….……………………… 38
表5-1假說及驗證結果………………………...……………………… 44

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