回顧過去整個管理的發展歷史與時空背景，可以發現管理的理論與實務一直不斷地在更新與精進，加上外在大環境產業的轉變，各個產業紛紛開始將管理的理論與實務推廣與應用到其不同產業型態上之組織的運作。隨著二十一世紀知識經濟的來臨，所孕育而生的「知識管理」，也成了各個產業與企業紛紛積極推行的焦點，早先，知識管理是由企業界先開始積極地推動，而其所帶來的成效與正面影響，就如同Drucker（1965）提及「知識」將取代機器、設備、資金、原料或勞工等有形資產，成為企業營運最關鍵的生產要素，而且「知識工作者」（Knowledge Worker）將取代傳統的勞動員工，成為企業創造效益的最佳利器。

同樣地，醫院本身也是一個組織，醫院內部的醫療人員，例如醫師與護理人員，其實也就是能推動知識管理的知識工作者，加上目前知識管理在醫療院所的推動，正處於起步階段，所以，本研究將以南部某醫院護理科，初探中階主管與基層護理人員對知識管理之瞭解與做法。此外，針對知識管理的推動，本研究將探討中階主管與基層護理人員在「知識取得」、「知識創造」、「知識儲存」、「知識擴散」與「知識應用」的實際做法與比較，並且探討加上在「知識管理促動因素」下，兩者在推動知識管理的結果為何。經由受訪者個案的研究分析與比較，本研究結果發現如下：
（一）中階主管與基層護理人員所重視的知識內容，主要還是以專業知識與技能，其次是服務性概念與病患的就醫環境和安全。
（二）中階主管與基層護理人員對於知識管理的推動，都認為是由大家彼此分工合作，各司其職，一起來推動知識管理，並沒有固定由專人負責推動知識管理的工作。
（三）中階主管與基層護理人員運用知識管理的程序與促動因素方面：
1. 在「知識取得」方面，單位內基層護理人員大多數的知識蒐集的來源來自於有書面的書籍、期刊、雜誌、報章，以及少部分的研究論文；中階主管在這部分，與基層護理人員是相似的，然而，不同的是，學術股副主任還會透過電子郵件作為知識蒐集的來源，臨床股副主任還有透過護理長作為知識蒐集的來源。
2. 在「知識創造」（創新）方面，中階主管與基層護理人員都認為醫院有獎勵機制，例如獎勵金或是提案獎金，其中有談到QCC的比賽獎金及研究經費，而且單位沒有與其他機構或機關合作做研究，但是有跟護理學校建立合作關係，開放實習生到院實習。
3. 在「知識儲存」方面，中階主管與基層護理人員認為護理科與單位內的知識大多是以書面文件方式儲存，這些書面文件的資料，通常是Key in在電腦的Word檔案裡面，並且存檔。然而，也有可能有一部分知識沒有形成書面文件儲存在知識庫或是藉由言語上的口頭分享，而形成了儲存在個人腦海裡的知識。
4. 在「知識擴散」方面，中階主管與基層護理人員對於知識擴散管道的常用排序則有不同，基層護理人員認為單位內知識擴散的管道常用排序前四名為非正式的溝通、查房的經驗傳承、病房會議（morning meeting）、教育訓練；中階主管則認為護理科知識擴散的管道常用排序前四名為在職教育訓練、會議的宣導與分享、研討會與讀書會，以及單位的查房。單位內知識擴散的機制，中階主管與基層護理人員認為教育訓練的知識擴散機制成效較好，同時，單位內也有圖書資料庫（指各護理單位內的圖書室），但是基層護理人員則認為其成效似乎並不理想。
5. 在「知識應用」方面，中階主管與基層護理人員都認為可以有效利用蓄積有文件與書面的知識庫，可以在短時間內找到需要的資訊，單位內的QCC是有助於品質的提昇，而且中階主管與基層護理人員也都認為對於醫院與單位教育訓練所習得的知識與技能是能夠應用在日常工作。
6. 在「知識管理促動因素」方面，中階主管與基層護理人員認為護理科與單位是鼓勵知識的分享，透過口頭上分享居多，以及開放、信任、適合員工彼此討論與分享，過半以上的基層護理人員與兩位中階主管的副主任也認為主管有給予足夠的鼓勵與支持，同時大多數的基層護理人員也認為理想的知識發展環境與薪資管理福利制度會讓她們更樂於分享知識與技能，尤其是薪資管理福利，然而，不同於基層護理人員的是，中階主管則認為上面主管的支持、好的領導與肯定才是讓她們更樂於分享知識與技能，再則，基層護理人員也普遍認為單位主管會考慮到不同層級與不同需求的員工，而給予教育訓練課程，中階主管的兩位副主任也認為護理科會考慮到不同層級與不同需求的員工，而給予教育訓練課程。

本研究最後也對該個案醫院提出四項建議：（一）完善知識平台的設置與應用；（二）增強獎勵機制的激勵與誘因；（三）提昇資訊能力的訓練課程；以及（四）增添知識管理的專職工作者。

Reviewing the whole development history of management and the era background, we can find that the theories and practices of management are always continuing changing and improving. In addition, each industry starts to promote and apply the theories and practices of management to the operation of its individual industry with the changes or evolvements of the all industries in the outside environment. With the coming of knowledge economy in the 21st century, here comes the birth of “knowledge management,” and it also becomes the focus of the active implementation in each industry and business enterprise. First, knowledge management is actively implemented in business enterprises, bringing great effects and positive influences just like what Peter Drucker said in 1965—“knowledge” is going to replace tangible assets such as machines, facilities, capital, materials, and labors, and becomes the most important key element of production in business enterprises. Besides, “knowledge workers” will also replace the traditional labors and become the most efficient instrument which brings great benefits to business enterprises.

Likewise, a hospital itself is an organization, too. In fact, the medical staffs in hospitals such as physicians and nurses are right the knowledge workers who are able to drive knowledge management. Moreover, the implementation of knowledge management in healthcare organizations or hospitals is still in the beginning phase. For this reason, the study will explore the realization and practice of knowledge management between middle level managers and basic level nurses. With regard to the implementation of knowledge management, the study is going to explore the practices and comparisons between the middle level managers and the basic level nurses in terms of knowledge acquisition, knowledge creation, knowledge storage, knowledge spread, and knowledge application, and to explore the outcomes of the implementation of knowledge management between these two levels under the enabling factors of knowledge management. Through the analyses and comparisons of the interview cases, here are the results and findings of the study:
1. The knowledge that the middle level managers and basic level nurses mainly value is the professional knowledge and skills of nursing. Then the concepts of services and the access environment and safety of patients are also concerned.
2. With regard to the implementation of knowledge management, the middle level managers and the basic level nurses both think that there is no specific or fixed one person who is responsible for the implementation of knowledge management but all people who work together to implement knowledge management according to their individual responsibility and accountability; that is, knowledge management is achieved by the division of labor.
3. As to the process and enabling factors of knowledge management exerted by the middle level managers and the basic level nurses, here are the outcomes:
(a) In terms of knowledge acquisition, for the basic level nurses in the units, the most sources of collected knowledge are from books, periodicals, magazines, and rarely theses; for the middle level managers, almost the same as the basic level nurses. However, there are still some differences. For example, the vice director in charge of academic affairs thinks e-mails are also one of the sources of collected knowledge; the other vice director in charge of clinical practices, the head nurses in the units are also one of the sources of collected knowledge.
(b) In terms of knowledge creation, both the middle level managers and the basic level nurses think that there is the mechanism of rewards in the hospital, such as the points of reward money and the reward money for new ideas. Furthermore, there are the competition reward money for QCC projects and the reward money for research proposals as well. Nevertheless, there is no cooperation in research between the nursing units in the hospital and other outside institutes or organizations, but there is cooperation relationship between the hospital and the nursing schools. For instance, the hospital is open for the nursing practicum of nursing students.
(c) In terms of knowledge storage, both the middle level managers and the basic level nurses think the knowledge stored in the nursing department and units is paper-oriented and documentation-oriented. The paper documentation is usually keyed in and saved in the Word files of computers. However, part of knowledge is possibly not presented through the paper documentation and not saved in so-called “knowledge base” but then stored in personal brain through the oral sharing.
(d) In terms of knowledge spread, there is one difference in the priority of the same ways frequently used to spread knowledge between the middle level managers and the basic level nurses. For example, the basic level nurses think the priority of the frequent ways used to spread knowledge in the units is informally oral dialogs, ward-checking, ward or morning meetings, and educational on-the-job training; the middle level managers, the priority of the frequent ways used to spread knowledge is educational on-the-job training, ward or morning meetings, seminars or studying clubs, and ward-checking. The best mechanism of knowledge spread in the units, both the middle level managers and the basic level nurses think, is educational on-the-job training. Meanwhile, there are also the small library rooms as the mechanism of knowledge spread in the units, but the effect of the library rooms is not that ideal in the viewpoints of the basic level nurses.
(e) In terms of knowledge application, both the middle level managers and the basic level nurses think that they can effectively use the knowledge base composed of documentation and paper to find the information they need in short time, and the QCC projects are conducive to the quality improvement. In addition, both of them also think the knowledge and skills learned from the on-the-job training for the whole hospital employees and for the unit nurses can be applied to daily work.
(f) In terms of the enabling factors of knowledge management, both the middle level managers and the basic level nurses think that the nursing department and the units encourage knowledge sharing and mutual discussion among employees. More than half of the basic level nurses think that the head nurses in the units offer them enough encouragement and support; the two vice directors as the middle level managers, their director offers them enough encouragement and support. Meanwhile, the majority of the basic level nurses think the ideal environment of knowledge development and the ideal welfare system of compensation management will make them be more delighted to share their knowledge and skills. However, the middle level managers think the support from the director, good leadership and positive approvals will make them be more delighted to share knowledge and skills. Moreover, most of the basic level nurses agree that the head nurses in the units will consider offering different courses of training to different employees according to their needs. The two vice directors as the middle level managers also think that the nursing department will also considering offering different courses of training to different employees according to their needs.

Finally, the study proposes four suggestions to the case hospital, such as (1) improving the installation and application of knowledge flat-top building, (2) reinforcing the motivation and incentive of the mechanism of rewards, (3) opening the training courses of upgrading information ability for the nurses, and (4) adding one specific worker who is only responsible for knowledge management.

目 錄
頁次
第一章 緒 論 1
第一節 研究背景與動機 1
第二節 研究問題與目的 3
第三節 研究流程 4
第二章 文獻探討 5
第一節 基層護理人員 5
第二節 知識的意涵 11
第三節 知識管理的定義 15
第四節 知識管理的架構 18
第三章 研究方法 22
第一節 質性研究方法 22
第二節 研究設計與過程 23
第三節 研究樣本 24
第四節 問卷編製 25
第五節 研究限制 27
第四章 研究結果的分析與比較 28
第一節 受訪者個案研究結果與分析 28
第二節 受訪者個案研究的比較 67
第三節 研究討論 91
第五章 結論與建議 94
第一節 結論 94
第二節 建議 96
參考文獻 100
一､中文部分 100
二､英文部分 102
附件一 訪談問卷內容 103
附件二 個案訪談摘要 105


表 目 錄
頁次
表2-1-1 公立醫院護理師與護士人數統計 5
表2-1-2 護理科統一進階制度中名詞界定和專科護理人員審查標準 6
表2-1-3 基層護理人員臨床專業能力訓練重點 8
表2-1-4 基層護理人員臨床專業能力進階制度晉升要求 9
表2-2-1 DAVEPORT & PRUSAK對企業知識之分類表 14
表2-3-1 知識管理之準則程序 17
表3-3-1 研究樣本概述表 24
表3-4-1 訪談問卷大綱 26
表4-2-1 學術股與臨床股在知識取得的比較 68
表4-2-2 學術股與臨床股在知識創造的比較 69
表4-2-3 學術股與臨床股在知識儲存的比較 70
表4-2-4 學術股與臨床股在知識擴散的比較 70
表4-2-5 學術股與臨床股在知識應用的比較 71
表4-2-6 中階主管與基層護理人員在知識取得的比較 72
表4-2-7 中階主管與基層護理人員在知識創造的比較 73
表4-2-8 中階主管與基層護理人員在知識儲存的比較 74
表4-2-9 中階主管與基層護理人員在知識擴散的比較 75
表4-2-10 中階主管與基層護理人員在知識應用的比較 76
表4-2-11 職務別與功能別在知識取得方面的比較 77
表4-2-12 職務別與功能別在知識創造方面的比較 78
表4-2-13 職務別與功能別在知識儲存方面的比較 79
表4-2-14 職務別與功能別在知識擴散方面的比較 80
表4-2-15 職務別與功能別在知識應用方面的比較 80
表4-2-16學術股在知識管理促動因素下對知識管理之影響 83
表4-2-17臨床股在知識管理促動因素下對知識管理之影響 85
表4-2-18中階主管在知識管理促動因素下對知識管理之影響 87
表4-2-19基層護理人員在知識管理促動因素下對知識管理之影響 90


圖 目 錄
頁次
圖1-3-1 研究流程圖 4
圖2-1-1 基層護理人員臨床專業能力進階制度概念架構 7
圖 2-3-1 知識管理文獻分類之準則程序觀 16
圖2-4-1 ARTHUR ANDERSON 知識管理重要元素 18
圖2-4-2 ARTHUR ANDERSON 知識管理模式 19
圖2-4-3 知識管理的6C觀念 21
圖4-2-1 職務別與功能別在知識管理促動因素下對知識管理之影響 81

一､中文部分
樂為良譯（1999），數位神經系統：與思考等快的明日世界，台北：商業周刊出
版。
陳椘杰（2001），醫院組織理論與管理，台北：宏翰文化。
陳依蘋（1999），知識管理的建立與挑戰，會計研究會刊，第169期，頁18。
王采白（2002），高科技產業知識管理文化與組織績效之關聯性分析，國立中山
大學人力資源管理研究所碩士論文，頁16-17。
李書政譯，知識管理─理論、評估、應用，台北：麥格羅•希爾。（原著：
Thomas Housel & A. H. Bell, 2001）
李振昌譯，16定位-Lotus總裁眼中網路時代，台北：大塊文化。（原著：J. P. Papows, 1999）
劉京偉譯，知識管理的第一本書，台北：商周。（原著：Arthur Anderson Business Consulting, 2000）
吳思華（1996），策略九說：策略思考的本質，台北：臉譜文化公司。
吳思華（1999），台灣如何面對知識時代之挑戰─知識管理與技術創新議題之座
談會，中山大學。
王瓊淑譯，笑傲第三波，駕馭知識經濟的管理法則，台北：經點傳訊。
（原著：J. Hope & T. Hope, 1999）
胡瑋珊譯，知識管理，台北：中國生產力。（原著：T. H. Davenport & L. Prusak, 1998）
張吉成、周談輝、黃文雄（2002），組織知識創新：企業與學校贏的策略，台北：五南。
劉常勇（2000），幾個有關知識管理議題之初探，
http://www.cme.org.tw/know/paper/paper/1.html，2000/06/24。
徐增明（2000），邁向知識世紀之國家創新系統及政策研究，國立政治大學88
學年度研究成果發表會，國立政治政治學管理科學研究所，6月20日。
徐恩普（2001），新經濟時代，細說知識管理，管理雜誌，第138期，頁92。
譚大純、劉廷揚、蔡明洲（1999），知識管理文獻之回顧與分類，中華民國科技
研討會論文集，（第一集），頁623-636。
胡幼慧編（1997），質性研究理論、方法及本土女性研究實例，台北：巨流出版
社。
夏侯欣鵬（2000），信任與權力對組織內知識分享意願影響之研究─以銀行放款
部門主管為例，國立政治大學企業管理研究所博士論文。
陳世彬（2001），知識管理之探究─我國政府研考部門之分析，國立中山大學政治學研究所碩士論文。
林肇利（2003），研發知識分享情境與研發績效之關係，國立中山大學人力資源管理研究所碩士論文。
黃耀論（2002），台商全球化知識管理與人力資本關係之研究，國立中山大學人力資源管理研究所碩士論文。
行政院衛生署統計室（2004），台灣地區醫療院所醫事人員數。
高雄市立聯合醫院護理科（2003），護理科統一進階制度中名詞界定和專科護理人員審查標準。
高雄市立聯合醫院護理科（2003），基層護理人員臨床專業能力進階制度概念架構。
高雄市立聯合醫院護理科（2003），基層護理人員臨床專業能力訓練重點。
高雄市立聯合醫院護理科（2003），基層護理人員臨床專業能力進階制度晉升要求。

二､英文部分
Anand, V., Manz, C.C., & Glick, W.H. (1998), “An organizational memory approach
to information management”, Academy of Management Review, Oct.,
796-809.
Bill Gates. (1999), “Business at the speed of thought: Succeeding in the digital
economy”, Warner Books Incorporated.
Davenport, T.H. & Prusak, L. (1998), “Working knowledge: How organizations
manage what they know”, Boston: Harvard Business School Press.
Davenport, T.H., Delong, W.D., & Beers, C.M. (1998), “Successful Knowledge Management Projects”, Sloan Management Review, Winter, 43-75.
Howells, J. (1996), “Tacit knowledge, innovation and technology transfer”,
Technology Analysis and Strategic Management, 8(2): 91-106.
Laurie, J., & Mark E. Van Buren. (1999), “Valuing investment in intellectual capital”,
International Journal of Technology Management, 18(5-8): 414-432
Nonaka, I. & Takeuchi, H. (1995), “The knowledge-creating company”, New York: Oxford University Press.
O’ Dell, C.S., Essaides, N., Jackson, C., & Grayson, C., Jr. (1998), “If only we knew what we know: The transfer of internal knowledge and best practice”, New York: Free Press.
Polanyi, M. (1967), “The Tacit Dimension”, New York: Routledge and Kegan Paul.
Prusak, L. (1997), “Knowledge in organizations”, New York: Butterworth-Heinemann.
Quinn, J.B. (1992), “Intelligent enterprise”, New York: The Free Press.
Quintas, P. (1997), “Knowledge management: A strategic agenda”, Long Range
Planning, 30(3): 385-391.
Seiby, K.E. (1996), “What is Knowledge Management”, http://www.brint.com.km/whatis.htm.
Stewart, T.A. (1997), “Intellectual Capital: The New Wealth of Organizations”, New
York: Bantam Doubleday Dell Publishing Group, Inc.
Thomas Housel & Arthur H. Bell (2001), “Measuring and Managing Knowledge”, McGraw-Hill.
Zack, H Michael (1999), “Managing Codified Knowledge”, Sloan Management
Review, Summer, 45-48.