現今，許多企業在長期的競爭下，在產品及服務流程的設計上，同質性愈來愈高，對手在有形的產品及服務流程上難已區分的同時，員工的服務品質成了企業能吸引顧客，且不易被模仿的競爭優勢。如Azzolini（1993）就提出內部人員功能品質與反應即是一項具有差異性與競爭優勢的決定性資源。Heskett（1990）提到內部服務品質可以提高工作滿意，進而傳遞高服務品質的產品與服務，以提昇外部顧客滿意度，增強顧客忠誠度，然後增加組織利潤與成長；如果員工沒有從他們的公司內接受到好的服務，就無法對外部顧客提供高品質的服務水準（Lynda & Emerson, 1991），然而直到最近，內部員工功能仍然被摒除在顧客滿意度的循環之外。
台灣民眾對醫療的需求快速膨漲，加上全民健保制度的推行，使得醫療產業逐年擴大，然而醫療產業是勞力密集的，除了透過醫療設施的使用外，還包含醫療服務人員，從顧客進入醫院就診開始至離開醫院的過程中，必須有許多醫療服務人員的參與才能發揮一定的醫療及服務功能。而在資訊流通快速的情形下，醫療機構的設備可經由採購而獲得相同或接近的水準，則顧客往往僅能以醫療服務人員傳遞的服務來區別這些機構的差異；而在醫療服務人員中，護理人員人數是最多的一環，也是與病患接觸最多的服務人員，在著重醫療服務品質的今日，護理人員的管理佔有舉足輕重的地位。
過去研究中，由於外部服務品質因子已受到廣泛的討論，而內部服務品質因子則較少被人重視，值得深入再探討。少數討論內部務品質的文章，多以探索性研究為主，或經由過去文獻的資料推論之；另外，也有部份研究進行實證調查，但其描述多以敘述性統計為主，且僅以比率來瞭解，並未加以檢定。
因此，基於護理人員的重要性、特殊的工作性質及人員需求；內部服務品質研究較少及缺乏驗證，本研究擬以護理人員為例，探討內部服務品質因子的內涵與管理上的意義。
本研究利用文獻探討、深入訪談及調查研究來確認內部服務品質因子、服務能力因子及外部服務品質因子。整理後，得到以下結論：
一、確認護理人員內部服務品質因子、服務能力、外部服務品質
1.萃取出九個護理人員認為影響其工作之內部服務品質因子，醫院管理者應可從九個方向著手，改善內部服務品質；因子如下：管理方式、單位間連繫、教育訓練、護理部支援、薪酬、責任劃分、資源、工作內容、醫院目標。
2.服務能力經因素分析後，合併為一個因子：服務能力。包含專業學理知識、技術與態度。
3.萃取出人員的外部服務品質兩個因子，分別是服務內容與服務效率。
二、確認護理人員個人變項對內部服務品質與服務能力、工作滿意與外部服務品質之影響及四變項之間關係。
再由調查研究與統計分析，整理後得到以下結論：
1.不同的個人特性對內部服務品質因子滿意度的認知會有所不同，整理見表6-1。其中僅在護理部支援與教育訓練兩個因子上，個人特性不同對其認知較沒有差異；其中對護理部支援因子的認知僅不同部別門間會有所差異；而對教育訓練的認知僅不同部門別與等級間有所差異。
2.所有的個人特性對服務能力、工作滿意的認知均顯現有差異，整理見表6-1。
3.不同的個人特性對外部服務品質因子－服務內容、服務效率，的認知會有所差異，整理見表6-1。
4.內部服務品質因子與服務能力、工作滿意度及外部服務品質因子大部份呈顯著的正相關，惟教育訓練因子對其他三個變項均無顯著關係；而工作內容更與工作滿及服務呈現顯著的負相關，見表6-2。此一現象對日益強調教育訓練及工作內容合理化之管理者而言，值得注意。
5.內部服務品質對服務能力的迴歸分析模式、內部服務品質對工作滿意的迴歸分析模式、內部服務品質對服務內容的迴歸分析模式、內部服務品質對服務效率的迴歸分析模式等四個模式，均表示極顯著。顯示本研究假設內部服務品質對服務能力、工作滿意及外部服務品質均有影響。
三、整體模式確認
整體而言，本研究所假設的觀念性架構有其參考價值，模式應屬合理，內部服務品質透過服務能力與工作滿意影響外部服務品質是很明確的，但是就內部服務品質直接對外部服務品質的影響的18項關係中卻多不顯著，可以顯見，研究中所找之中介變項，服務能力及工作滿意效果佳，將內部服務品質直接對外部服務品質的影響大部都吸收了。

The competition between product and service procedure is more and more alike. Because it is difficult to distinguish the differences between hospitals on both tangible product and service procedure, the most important is service of employee. The service of employee is a competitive advantage and is hard to copy. Azzohlini (1993) mentioned the function quality and response of internal employee were important resources that revealed the discrepancy between each enterprise and the competitive advantage of it. Heskett, et al. (1994) mentioned that the model was related to the concept of service-profit chain. They thought the internal service quality to employees would strengthen the satisfaction, royalty and productivity of employees, then creating high service value. High service value brought out high external customer satisfaction and royalty. That is why the internal service quality is so important to organizational profit and revenue growth. And most of the researchers agree that only satisfied employees can create satisfied customers.
In Taiwan, the government has advanced the system of medical insurance, so the need of medical treatment is expanding. The service of hospital includes facility and employee. When the patient enter the hospital for their disease, many employees have to take care of them. The employees are doctors, pharmacists, nurses, administrative staff, and so on. The greater part of employees is nurses. They are the front line to contact with and care for patient. The service of nurse is very important and is hard to copy.
Researchers have found many factors of external service quality and developed measuring methods for service quality from the perspective of customers ( Parasuraman, Zeithaml & Berry, 1985; George & Gronroos, 1989； Heskett, 1990). In the meantime, the measurement of internal service quality was hardly mentioned. Yes, some researcher paid attention to this topic. They discussed the significance of internal service quality from other researches or their own observation. But we need more information about it. So this research tries to find the factors of internal service quality and explores the relationship between the internal service quality, the job satisfaction, the service ability and external service quality.
After interviewing nurses, we integrated the data of the interviews and the exploration of other research papers to develop the questionnaire. The questionnaire had been filled out by the nurses who work in large-scale hospital. We induce the following results:
(1) The factors of internal service quality are as follows: the style of management, the contact with other department, the training, the support of nursing department, the reward, the correct and definite responsibility, the resources, the content of job and the target of hospital.
(2) The service ability include the professional knowledge, techniques and attitude.
(3) The factors of external service quality about employee include the content of service and the efficiency of service.
(4) Because of different personal characteristic, nurses have different recognition to factors of internal service quality except the training and the support of nursing department.
(5) The different personal characteristic may brings out different recognition of service ability, job satisfaction.
(6) The different personal characteristic may brings out different recognition of factors of external service quality about employee.
(7) The correlation between factors of internal service quality, service ability and job satisfaction is positive except the training and the content of job.
(8) The regression models that include internal service quality-service ability model, internal service quality-job satisfaction model, internal service quality-content of service model and internal service quality- efficiency of service model are significant.
(9) For full model, the structure of model is fit except the direct relationship between internal service quality and external service quality about employee. We think the relationship is transmitted by job satisfaction and service ability.

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 5
第二章 文獻探討 9
第一節 護理人員的特性 9
第二節 內部顧客與內部服務品質的概念. 11
第三節 工作滿意、服務能力及外部服務品質 18
第四節 醫療服務人員內部服務品質與外部服務品質相關研究. 28
第三章 個案訪談研究 30
第一節 文獻分析 30
第二節 深度訪談方法及設計 31
第三節 研究護理人員的理由 34
第四節 內部服務品質因子的確認 36
第五節 服務能力因子的確認 56
第六節 工作滿意度的衡量 59
第七節 外部服務的衡量 60
第八節 訪談結果 61
第四章 調查研究設計 63
第一節 變項定義 63
第二節 量表發展 63
第三節 資料收集 65
第四節 樣本分析 66
第五節 資料分析方法 67
第五章 結果分析 69
第一節 內部服務品質因子、服務能力及外部服務品質因子萃取 69
第二節 各變項特性分析 75
第三節 各變項間相關分析 95
第四節 模式驗證 100
第六章 結論與建議 102
第一節 結論與管理上的意涵 102
第二節 研究限制 108
第三節 建議 108
參考文獻 111
附錄 118

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