論文名稱：醫院組織文化之探討：以一家醫學中心為例 頁數：153
校院系所：國立中山大學人力資源管理研究所
畢業時間及提要別：88學年度第2學期碩士論文摘要
研究生：劉士毅( Shih-Yie Liu) 指導教授：任金剛(Ckin-Kang Jen)

論文摘要內容
本研究針對台灣地區一家醫學中心級的私人財團醫院進行組織文化的探討與描述，並試圖提供個案醫院在做組織變革時的一個參考資料。本研究採個案研究與質化研究法進行資料的蒐集與分析；本研究的訪談資料共計二十一筆，其中團體訪談資料計6筆，個別訪談資料計十五筆。
本研究分析的工具則依照Schein對組織文化的解讀方式而得到本研究的結果。包括：
(1) 人類活動的本質取名為醫院的定位，其基本假設為「相互依存」，其外顯價值觀為自力更生與醫事專業倫理兩種。(2) 人性的本質取名為管理本質，其基本假設為「不善不惡型」，其外顯價值觀為放任式管理、尊重醫療專業自主性等兩種。(3) 真理的本質，其基本假設為『擁有權力即擁有權力決定權』，其外顯價值觀為權力核心價值觀。(4) 時間的本質，其基本假設為「過去取向」，其外顯價值觀為念舊情懷價值觀。(5) 空間本質：其基本假設為「鞏固地盤」，其外顯價值觀具有城堡形態色彩價值觀。(6) 人際關係本質，其基本假設為「泛家族主義」，其外顯價值觀有個人對組織的感情深厚、同事之間的私人情誼、下對上的長幼遵從、上對下的關懷之情等四種價值觀。

另外，本研究提出的命題如下：
命題一：具有泛家族主義型態的組織，資歷較年輕的成員若沒有特殊關係、沒有獲得權力核心團體的支持時，其在能力發揮的空間上受到一定程度上的限制。
命題二：具有泛家族形態的組織，同事之間的情誼存在於部門內成員之間相對於部門與部門成員之間的表現上會更加融洽，並且相互扶持的味道也更加濃厚。
命題三：大型組織內所劃分出功能性單位越多，負責各單位的主管在帶領成員、決策過程時，其表現出的領導型態會有不盡相同的類別。

關鍵字：組織文化、醫院文化、組織文化價值觀

The Study and Analysis of Hospital Organizational Culture:
A Medical Center’s Research

Abstract
This study tries to research hospital organization culture of a private medical center in Taiwan region and tries to provide a reference data when this hospital wants to do their organization’s diagnosis. This research’s analysis has been finished by one case study and quality research method. About interview data totality are twenty-one cases, among which six cases are to be part of group’s interview; the other fifteen cases are individual’s interview.
The analysis tools of this study according to Schein’s read method of organization culture research and then to obtain below conclusions, including:
(1) The nature of human activity named hospital’s orientation, its basic assumption is “being-in-becoming” orientation, and its values include two types: self-reliance and morality of medical matters. (2) The nature of human nature named management orientation, its basic assumption is human are thought to be motivated by monetary considerations, while in others employees are thought to be motivated by need for social approval or the potential for self-actualizations; and its values include also two types: permissive management and esteem one’s own master in medicine matters. (3) The basic assumption of nature of reality and truth is that who own power and he also can to make decision, its value is authority center. (4) The basis assumption of the nature of time is past-time orientation, its values is to cherish past feelings. (5) The basic assumption of the nature of space is to strengthen one’s territory, its values seems castle style. (6) The basic assumption of the nature of human relationship is simulate-familism, it values include the deep-seated feelings of employee toward to their organization, personal friendships, employee to comply with the preceding generation and leaders concern about their employees.

Furthermore, the propositions are as follows:
Proposition 1: If one who don’t have some kind of relationship or don’t support by authority group, employee can’t do what he want to do in his professional field in simulate-familism organization.
Proposition 2: In simulate-familism organization, personal friendship within sectors will more obvious than being between different departments.
Proposition 3: When organization functions have been to divide more diversity, its managers of each unit will display his personal leadership.

Key words: Organization Culture; Hospital Culture and Organization Culture values.

目 錄
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2

第二章 文獻參考 3
第一節 組織文化的概念 3
第二節 醫院的組織文化 14
第三節 醫院組織文化的研究方法 20
第四節 小結 25

第三章 研究方法 27
第一節 個案研究法與質性研究 27
第二節 研究個案基本資料 32
第三節 研究流程 35

第四章 研究分析結果 44
第一節 醫院的定位 44
第二節 管理本質 56
第三節 真理、時間與空間本質 64
第四節 人際關係本質 80

第五章 研究討論與建議 94
第一節 研究結果 94
第二節 本研究的貢獻與限制 100
第三節 建議 105

參考文獻 108
一、中文部份 108
二、英文部份 110
附 錄 117
附錄一：訪談問題大綱（一） 117
附錄二：訪談問題大綱（二） 119
附錄三：A醫院組織文化各價值觀推導過程圖 120
附錄四：登錄表 126
附錄五：訪談稿摘錄 133

圖 次
圖2-1 文化理論與組織理論的交集 (Smircich, 1983) 4
圖2-2 Schein (1992) 的文化模式 8
圖2-3 Ott (1989) 組織文化層次及其間的互動關係圖 9
圖2-4 Hofstede的文化模式 11
圖2-5 醫院管理的領域 16
圖3-1 A醫院組織圖 34
圖3-2 本研究流程圖 36
圖3-3 資料分析過程圖 43
圖4-1 自力更生價值觀的形成 45
圖4-2 醫事專業倫理價值觀的形成 50
圖4-3 放任式管理價值觀的形成 57
圖4-4 尊重醫療專業自主性的形成 59
圖4-5 權力核心價值觀的形成 64
圖4-6 念舊情懷價值觀的形成 70
圖4-7 城堡主義價值觀的形成 75
圖4-8 對組織感情深厚價值觀的形成 81
圖4-9 同事之間的私人情誼的形成 85
圖4-10 下對上的長幼遵從價值觀的形成 87
圖4-11 上對下的關懷之情價值觀的形成 92
圖5-1 A醫院文化解讀的架構 95
圖5-2 科室內的小型城堡型態 96
圖5-3 三家醫院的組織文化對照比較曲線圖 101
圖5-4 組織文化發展歷程圖 106


表 次
表2-1 組織文化模式 12
表2-2 B、C兩家醫院之組織文化比較 18
表3-1 A醫院員工人數統計表 32
表3-2 A醫院現有病床類別及床數 33
表3-3 研究者於護理部見習時間表 38
表3-4 研究者於藥劑科實習時間表 39
表3-5 醫院代號表 40
表3-6 受訪人員編碼表 41
表3-7 受訪者基本資料表 42

一、中文部份

任金剛（1996）。組織文化、組織氣候、及員工效能：一項微觀的探討。台灣大學商學研究所未出版博士論文。

行政院研究發展考核委員會(1981)。財團法人制度之探討。

李茂雄(2990)。淺談醫院之組織文化，人事行政，96期，P.31-38.台北：中國人事行政學會出版委員會。

杜如茵(1991)。醫院內部控制與成員組織承諾。政治作戰學校新聞研究所未出版碩士論文。

陳千玉(1995)。組織文化之探討與解讀：以一家大型民營企業為例。政治大學心理研究所未出版碩士論文。

夏林清(1994)。從研究者的『自我反應』探討研究關係之意涵：兩種不同研究方法之比較。中央研究院民族研究所舉辦『社會科學研究方法檢討與前瞻』第二次科際研討會之報告。

張錦文、譚開元、黃佳經(1991)。醫院管理 。臺北：水牛出版社。

張少娟(1996)。兩家醫院組織文化之探討。台灣大學心理研究所未出版碩士論文。

彭朱如(1990)。省立醫院組織文化與生產績效之研究。中國醫藥學院醫院管理研究所未出版碩士論文。

楊國樞(1992)。中國人的社會取向：社會互動的觀點。載於楊國書、余安邦（編）：中國人的心理與行為--理念及方法篇。台北：桂冠出版公司。



鄭永忠(1996)。大型醫院組織文化、組織運作、經營管理及經營績效之關係研究。成功大學企業管理研究所未出版碩士論文。

鄭伯壎(1995)。不同家長權威價值與領導作風的關係。行政院國科會研究成果報告。NSC 83-0301-Ｈ-002-056。

鄭毓仁(1983)。醫院組織設計之研究。中山大學企業管理研究所未出版碩士論文。


Schein, E. H.(1992). 。陳千玉(1996)譯。組織文化與領導(Organizational culture and leadership,2nd)。台北：五南出版社。

Wolcott, H. Q. (1990). 。顧瑜君(1998)譯。質性研究寫作(Writing up qualitative research)。台北：五南出版社。



二、英文部份

Alvesson, M. (1987). Organizations, culture, and ideology. International Studies of Management and Organization, 13(3), 4-18.

Alvesson M., & Berg, P. O. (1992). Corporate culture and organization symbolism. Berlin: Walter de Gruyter.

Anderson, N. & West, M.A. (1992). Innovation, cultural values, and the management of change in British hospital. Work and Stress, 6(3), 293-310.

Barley, S. R. (1983). Semiotics and the study of occupational and organizational cultures. Administrative Science Quarterly, 28, 393-413.

Barney, J. B., (1986). Organizational culture: can it be a source of sustained competitive advantage? Academy of Management Review, 11(3), P.663.

Bice, M. O. (1984). Corporate cultures and business strategy: A health management company perspective. Hospital & Health Services Administration, 29(4), 64-78.

Borum, F., & Pedersen, J. S. (1990). Understanding the IT people, the subcultures, and the implications for management of technology. In F. Borum, A.L. Friedman, M. Monsted, J. S. Pederson, & M. Risberg(Eds.), Social dynamics of the field: The case of Denmark: 105-120.

Broms, H., & Gahmberg, H. (1983). Communication to self in organizations and cultures. Administrative Science Quarterly, 28, 482-495.

Buchanan, D. & Claydon, T. & Doyle M. (1999). Organization development and change: The legacy of the nineties. Human Resource Management Journal, 9(2), 20-37.

Bush L. E. (1999). Building Special Forces to last: redesigning the organizational culture. Special Warfare, 12(3), 16-20.

Coeling, H. & Wilcox, J. R. (1988). Understanding organizational culture: A key to management decision-making. Journal of Nursing Administration, 18(11), 16-24.

Coeling, H. & Simms, L.M. (1993). Facilitating innovation at the nursing unit level through cultural assessment, part 1: how to keep management ideas from falling on deaf ears. Journal of Nursing Administration, 23(4), 46-53.

Cook, R. A. & Lafferty, J. C. (1983). Level V: Organizational culture inventory-form I and form Ⅲ, Ply mouth, MI: Human Syngeristics.

Cook, R. A. & Rousseau, D. M. (1988). Behavioral norms and expectations: A quantitative approach to the assessment of organizational culture. Group and Organizational Studies, 13(3), 245-273.

Czarniawska-Joerges, B. (1988). Ideological control in nonideological organizations. New York: Praeger.

Czarniawska-Joerges, B. (1992). Exploring complex organizations: A cultural perspective. Newbury Park, CA: Sage.

Deshpande, R. & Webster, F. E. (1989). Organizational culture and marketing: Defining the research agenda, Journal of Marketing, 53(January), 3-15.

Denison, P. R., & Spreitzer, G. M. (1991). Organizational culture and organizational development: A competing values approach. Research in Organizational Change and Development, 5, 1-21.

Dyer, W. G. (1985). The cycle of cultural evolution in organization. In R.H.Kilmann, M.I.Saxton, R.Serpa (Eds.), Gaining control of the corporate culture. San Francisco: Jossey-Bass.

England, G. (1975). The manager and His Values. New York: Ballinger.

Fllegeer, M. E. (1993). Assessing organizational culture: A planning strategy. Nursing Management, 24(20), 39-41.


Gagliardi, P. (Ed.). (1990). Symbols and artifacts: Views of the corporate landscape. Berlin: Walter Press.

Gregory, K. (1983). Native view paradigms: Multiple cultures and culture conflicts in organizations. Administration Science Quarterly, 28, 359-376.

Gordon, G. G. (1991). Industry determinants of organizational culture. Academy of Management Review, 15(2), 396-415.

Hansen, C. D. & Kahnweiler, W. M. & Wilensky, A. S. (1994). Human resource development as an occupational culture through organizational stories. Human Resource Development Quarterly, 5(3), 253-269.

Hatch, M. J. (1993). The dynamics of organization culture. Academy of Management Review, 18(4), 657-693.

Hofstede, G., Ncuijen, B., Ohayv, D. D., & Sanderts, G. (1990). Measuring organizational cultures: A qualitative and quantitative study across twenty cases. Administrative Science Quarterly, 35, 286-316.

Higgins, S. E. & Routhieaux R. L. (1999). A multiple-level analysis of hospital team effectiveness. The Health Care Manager, 17(4), 1-13.

Jones, M. O. (1988). How does folklore fit in? Paper presented at the annual meeting of the Academy of Management, Anaheim, CA.

Kilmann, R. H., Santon, M. J., & Serpa, R. eds. (1985). Gaining Control of Corporate Culture, San Francisco, Calif:Jossey-Bass.

Klingle, R. S., Burgon, M., Afifi, W., & Callister, M. (1995). Rethinking how to measure organizational culture in the hospital setting--the Hospital Culture Scale, Evaluation and the Health Professions, 18(2), 166-186.

Kluckhohn, F. R. & Strodtbect, F. L. (1961). Variations in Value Organizatations. New York:Harper & Row.


Klunk, S. W. & Panetta, J. & Wooten, J. (1996). Accelerating the culture change. Hospital Materiel Management Quarterly, 18(2), 14-25.

Kreiner, K. (1989). Culture and meaning: Making sense of conflicting realities in the workplace. International Studies of Management Organization, 19(3), 64-81.

Lather, Patti. (1986). Research as praxis. Harvard Educational Review, 56(3).

Louis, M. R. (1983). Organizations as culture bearing millieux. In L. R. Pondy, P. J. Frost, G. Morgan, & T. C. Dandridge (Eds.). Organizational symbolism, 39-54.

Martin, J. & Siehl, C. (1983). Organizational culture and counter-culture: An uneasy symbiosis. Organizational Dynamics, 12(2), 52-64.

McDaniel, C. & Stumpf, L. (1993). The organizational culture implications for nursing service. Journal of Nursing Administration, 23 (4), 54-60.

Mendonsa R. M. (1999). Riding the waves of culture: understanding cultural diversity in business. Human Resource Development Quanterly, 10(2), 185-188.

Miles M. B. & Haberman A. V. (1985). Qualitative Data Analysis, 3rd eds. Newbury Park, CA: Sage.

Mills, A. J. (1988). Organization, gender, and culture. Organization Studies, 9(3), 351-369.

Nystrom, P. C. (1993). Organizational cultures, strategies, and commitments in health care organizations. Health Care Management Review, 18(1), 43-49.

Ott, J. S. (1989). The organizational culture perspective. Pacific Grove, CA:Brooks/Cole.

O’Reilly, C. A. & Chatman, J. & Caldwell, D. F. (1991). People and organizational culture: A profile comparison approach to assessing person-organization fit. Academy of Management Journal, 34(3), 487-516.

Ouchi, W. G. (1979). A conceptual framework for the design of organizational control mechanisms. Management Science, 25, 833-848.

Ouchi, W. G. (1981). Theory Z: How American businessman meet the Japanese challenge. Reading, MA. : Addison-Wesely.


Pedersen, J. S. (1991). Continuity and change: Central perspectives on organizational change and transformation in information technology firm. Copenhagen, Denmark: Copenhagen Business School, Institute of Organization and Industrial Sociology.

Pedersen, J. S., & Sorensen, J. S. (1989). Organizational culture in theory and practice. Aldershot, England: Avebury & Gower.

Pettigrew, A. (1979). On studying organizational culture. Administrative Science Quarterly, 24, 570-581.

Phillips, M. E. (1990). Industry as a cultural grouping. Unpublished doctoral dissertation, University of California, Los Angeles.

Pondy, L. R., Frost, P. J., Morgan, G., & Dandridge, T. C. (Eds.) (1983). Organizational Symbolism. Greenwich, CT: JAI Press.

Sathe, V. (1985). How to decipher and change corporate culture. In R. H. Kilmann, M. I. Saxton, R. Serpa, & associates(Ed.), Gaining control of the corporate culture, San Francisco: Jossey-Bass.

Schein, E. H. (1985). Organizational Culture and Leadership. 1st edition, San Francisco: Jossey-Bass.

Schein, E. H. (1990). Organizational Culture. American Psychologist, 45(2),109-119.

Schein, E. H. (1992). Organizational culture and leadership. 2nd edition. San Francisco: Jossey-bass.

Sherriton, J. & Stern, J. (1997). HR's Role in Culture Change, HR Focus, 74 (4), p.27.


Smircich, L. (1983). Concepts of culture and organizational analysis, Administrative Science Quarterly, 28, 339-358.

Stahl, R. A. & Andersen, S. L. (1996). Leadership and change management. Hospital Materiel Management Quarterly, 17(3), 54-63.

Stephen, M. S., Denise, M., Robin, R. G., Kelly, J. D. & Tony, L. S. (1991). Organizational assessment in Intensive Care Units (ICUs): Construct development, reliability, and validity of the ICU nurse-physician questionnaire, Medical Care, 29 (8), 709-723.

Simon & Schuster, (1988). Webster's New World Dictionary, Third College Edition, New York.

Veninga, R. L. (1982). Understanding the culture of organizations, Human side of Health Care Organizations.

Thomas J. R. (1996). Redefining Diversity, New York, NY: AMACOM;

Trice, H. M. & Beyer, J. M. (1984). Studying organizational culture through rites and ceremonials. Academy of Management Review, 9, 653-669.

Trice, H. M. & Beyer, J. M. (1993). The cultures of work organizations. Englewlood Cliffs, N. J.: Prentice Hall.

Turner, B. A. (1986). Sociological aspects of organizational symbolism. Organizational Studies, 7, 101-115.

Turner, B. A. (Ed.). (1990). Organizational symbolism, Berlin: Walter de Gruyter.

Van Maanen, J., & Barley, S. R. (1985). Cultural organization: Fragments of a theory. In P. Frost, L. Moore, M, Louis, C. Lundberg, & J. Martin (Eds.). Organizational Culture, 31-54.

Vroom, R. M. (1973). Handbook of leadership: A survey of theory of research. New York: Free Press.


Wilkins, A. (1978). Organizational stories as an expression of management philosophy: Implications for social control in organizations. Unpublished doctoral dissertation, Stanford University.

Wilkins, A. L. (1983). The culture audit: A tool for understanding organization. Organizational Dynamics, 11, 24-38.

William Umiker (1999). Organizational culture, the role of management and supervisors. The Health Care manager, 17(4), 22-27.

Yin, R. K. (1989). Case study research: Design and methods, Newbury Park, CA: Sage.

Young E. (1989). On the naming of the roses: Interest and multiple meanings as elements of organization culture. Organization Studies, 10, 187-206.

Zack Mansdorf, (1999). Organizational culture and safety performance. Occupational Hazards, 61(5), 109-112.