論 文 摘 要
當二十一世紀到來，由於經濟的快速成長，人民所得增加，全世界都面臨相同的問題－不僅只是滿足基本需求而已，更需求生活品質的提升，以及充足完善的醫療保健服務。如今醫療業應以擁有服務意識及就醫者導向行為的員工方能成能醫療業成功的關鍵資源。本研究的目的主要是探求，影響醫療服務業第一線員工之就醫者服務行為的因素有那些，以高雄市立醫院第一線員工為研究對象，試著實證出將行銷概念運用醫院內部行銷管理作為，及是否會透過組織承諾與組織服務性氣候，而對員工就醫者導向服務行為產生影響。研究結果發現如下：
１． 當醫院於組織內採行內部行銷管理作為時，對醫院內員工的組織情感性承諾與規範性承諾有顯著正向影響，但內部行銷之管理支援及工作自主卻對員工持續性承諾則有顯著的負向影響，而重視員工對持續性承諾無顯著的影響。
２． 當醫院於內部採行內部行銷管理作為時，會使員工對組織服務性氣候有較高的知覺。
３． 組織承諾中的情感性承諾，規範性承諾與組織的服務性氣候皆對以患者為主之就醫者導向有顯著正影響，而情感性承諾與組織服務性氣候與以員工為主之就醫者服務行為有顯著負向影響。至於持續承諾、規範性承諾分別對以患者為主，以員工為主之就醫者導向服務行為無顯著的影響。
４． 內部行銷二個構面中，管理支援及工作自主對就醫者服務行為有顯著的影響效果，但重視員工則對以患者為主就醫者服務行為有顯著影響，對以員工為主之就醫者服務行為則無顯著的影響。至於內部行銷透過中介變項組織服務性氣候和規範性承諾對以患者為主之就醫者導向服務行為產生影響。
故醫院實施內部行銷管理時－需注意中介變數（規範性承諾、組織服務性氣候）的變化，以確保員工就醫者服務行為的建立。

The Relationship between Internal Marketing and Patient Oriented Behavior
—The Evidence from Kaohsiung Municipal Hospital
In 21th century , not only the life quality but also medical care is perfect was requested by the people. The quality of service is highly related to the front-line worker. According to the literature review, the internal marketing has am important impact on the customer-oriented behavior. This article is empirical study to prove the influence of internal marketing on the patient-oriented behavior of front-line employees in medical care.
The results showed that:
1.Adopting the conduct of internal marketing has an positive impact on affective and normative commitment of organization; but management support has a negative impact on continuance commitment, while thinking highly of staff has no effect on continuance commitment.
2.Adopting the internal marketing conduct has positive impact on organization climate for service.
3.Affective commitment, normative commitment and organization climate for service has positive impact on patient-oriented serving behavior. However, affective commitment and organization climate for service has negative impact on staff-oriented serving behavior. While there is no significance both in continuance commitment comparing with patient-oriented serving behavior and normative commitment comparing with staff-oriented serving behavior.
4.Adopting the internal marketing has a positive impact on patient-oriented serving behavior. However, management support has a positive impact on staff-oriented serving behavior; but thinking highly of staff has no effect on staff-oriented serving behavior. The study also indicated that internal marketing show a positive influence on patient-oriented serving behavior through normative commitment and organization climate for service. So the managers must concern the mediators such as normative commitment and organization climate for service while put internal marketing on the hospital to make sure patient-oriented serving behavior will perform.

Key Words: Internal Marketing, Patient-Oriented, Staff-Oriented, Serving
Behavior

目　　　錄
頁次
第一章 緒論
第一節　研究動機…………………………………………………….……….1
第二節　研究目的…………………………………………………….……….6
第三節　研究步驟…………………………………………………….……….7

第二章 文獻探討
第一節　醫療服務業的定義、行銷………………………………………….9
第二節　內部行銷…………………………………………………….………15
第三節　內部行銷對組織的影響…………………………………….………25
第四節 顧客、就醫者導向行為…………………………………….………40

第三章 研究方法
第一節　研究架構…………………………………………………….……….45
第二節 研究假設…………………………………………………….……….48
第三節　研究變項操作型定義與衡量……………………………….……….50
第四節　資料蒐集方法與研究樣本………………………………….……….54
第五節　資料分析方法……………………………………………….……….57
第六節 因素分析、信度與效度分析……………………………….……….58
第七節 研究限制…………………………………………………….……….63

第四章 分析結果與討論
第一節　各研究變項描述性統計分析……………………………….……….66
第二節 不同個人特徵在內部行銷各相關變數上之差異分析…….……….75
第三節　內部行銷與各相關變數之相關分析……………………….……….87
第四節　內部行銷與就醫者導向服務行之淨相關分析…………….……….93

第五章 結論與建議
第一節　結論…………………………………………………….……………95
第二節　建議…………………………………………………….…………..104

參考文獻…………………………………………………….……………………107
附錄－研究問卷

表　　目　　錄
頁次
表2-2-1　內部行銷的定義、彙整………………………………………………17
表2-3-1　組織承諾的定義…………………………………………. …………..27
表2-3-2　組織承諾及其前因變項關係的研究………. ……………. ………….29
表2-3-3　組織承諾及其結果變項關係之研究………. ……………. ………….30
表2-3-4　組織承諾的分類…………………………………………. ……………31
表3-4-1　研究樣本特性…………………………………………. ………………56
表3-6-1　「內部行銷」之因素分析……………………………. ………………60
表3-6-2　「組織承諾」之因素分析……………………………. ………………61
表3-6-3　「就醫者導向行為」之因素分析……………………………. ………62
表4-1-1　整體樣本在各變數之描述性分析……………………………. ……….66
表4-1-2　醫院樣本各構面之描述性分析表……………………………………..67
表4-1-3　男、女樣本在各構面之描述性分析表………………………………..68
表4-1-4　各年齡層在各構面之描述性分析表…………………………………..69
表4-1-5　婚姻狀況在各構面之描述性分析表…………………………………..70
表4-1-6　教育情況在各構面之描述性分析表…………………………………..71
表4-1-7　工作年資在各構面之描述性分析表…………………………………..72


頁次
表4-1-8　職務類別在各構面之描述性分析表………………………………….73
表4-1-9　職階類別在各構面之描述性分析表………………………………….74
表4-2-1　個人特徵在對「管理支援及工作自主」之差異分析表……….……76
表4-2-2　個人特徵在對「重視員工」之差異分析表………………………….78
表4-2-3　個人特徵在對「情感性承諾」之差異分析表……………………….79
表4-2-4　個人特徵在對「規範性承諾」之差異分析表……………………….81
表4-2-5　個人特徵在對「持續性承諾」之差異分析表……………….………82
表4-2-6　個人特徵在對「服務性氣候」之差異分析………………………….83
表4-2-7　個人特徵在對「以患者為主之就醫者服務行為」之差異分析表….85
表4-2-8　個人特徵在對「以員工為主之就醫者服務行為」之差異分析表….87
表4-3-1　內部行銷與各相關變數之相關分析表……………………………….89
表4-3-2　就醫者導向行為與各相關變數之相關分析表……………….………90
表4-3-3　研究架構中各變數間之相關分析表………………………….………91
表4-3-4　就醫者導向之服務行為對內部行銷、組織服務性氣候、組織承諾
逐步迴歸分析表……………………………………………….………92
表4-4-1　內部行銷與就醫者導向之服務行為淨相關分析表…………….…….94
表5-5-1　差異性假設驗證表…………………………………………………….99
表5-5-2　影響性假設驗證表………………………………………….…….…102
圖 目 錄
頁次
圖1-1-1　健康醫療機構關係行銷系統…………………………………………3
圖1-1-2　內部行銷的顧客導向…………………………………………………5
圖1-3-1　本研究之研究步驟……………………………………………………8
圖3-1-1　研究架構圖…………………………………………………………..47

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