近年來，醫療市場自從健保開辦後有呈現大小兩級化的趨勢。在大者衡大的情況下大型醫院不斷擴充，使得中小型醫院的生存空間不斷受到打壓，加上健保制度及支付制度設計不甚合理，使得醫療院所增加互相間的競爭。根據江東亮（2000）及黃明山（2000）的研究指出，在全民健康保險實施後有77%的醫院經營管理者認為醫療院所之間的競爭明顯的增加。
因此在對於現行醫療環境的衝擊及生存的壓力下所帶來預期組織將可能發生變革的預期心理情況下也許會引發員工對於本身工作產生不安全感（job insecurity），而此不安全感對其工作的反應會是如何，在醫院管理實務上具有何種涵意。本文希望藉由實際的推論找出預期醫院組織改變員工產生不安全感的感受下，對醫院員工的工作反應為何？並加入員工個人人格特質的差異變項之後，其關連性為何？
經由實證分析，本研究主要發現如下：
1. 預期組織改變的因素裡工作情境變動、人力結構變動、組織經營型態變動、就業機會變動均與工作不安全感有顯著的正相關。亦即工作情境變動、人力結構變動、組織經營型態變動、就業機會變動分數越高，則越容易產生工作的不安全感。
2. 對工作不安全感而言，預期組織變動的因素模型組對於工作不安全感解釋變異量達非常顯著之水準，且預期組織改變的工作情境變動及就業機會變動均有顯著的影響力。
3. 工作不安全感在預期組織改變與組織承諾、離職傾向、工作滿足、服務態度間之中介效果有部份顯著。
4.具內控人格特質傾向的醫院員工，對於工作情境變動、就業機會變動及組織經營型態變動與工作特性改變之不安全感的干擾效果較明顯。具外控人格特質傾向的醫院員工，對於人力結構變動與工作特性改變之不安全感及工作異動之不安全感的干擾效果較明顯。

There is a trend that the phenomenon of inequality is behaved in the market of medical treatment after the exercise of public health insurance. The large-scale hospitals incrementally enlarge to squeeze the survival condition of small and medium hospitals under the situation that supreme will survive to enhance competitive advantage. The competition is fierce between local hospitals to be based on the inequality of survival condition and unreasonable payment system of public health insurance. The research of Tong-Liang Chiang and Ming-San Huang (2000) indicates following phenomenon: the 77% of manager of local hospitals think that the competition is obviously increased between local hospitals after the exercise of public health insurance.

The job insecurity of employees is generated by the expecting psychological condition that is derived from change in the organization under the impact of current environment and pressure of survival. What is the response of work influenced by job insecurity? What is the management lesson of hospital brought in the competition of hospitals? I hope to find the real response of employees under situation that feeling of job insecurity is derived by the expecting psychological condition of change in the organization. What is the relationship by the addition of individual personality?

There are main findings in the research through the analysis of evidence:

1. Job insecurity is evident positive relevant to variation on work scenario, variation on structure of human resource, variation on management pattern of organization and variation on opportunity of employment that is belongs to the expecting factor of change in the organization. The higher score of variation on work scenario, variation on structure of human resource, variation on management pattern of organization and variation on opportunity of employment, the much easier generation of job insecurity.

2. For the job insecurity, the deviation of explanation on job insecurity is evidently related with the model of expecting factor of change in the organization. And the variation on work scenario and variation on opportunity of employment are evidently influenced by job security.

3. Job insecurity is partial evidently related with the immediate effect that is derived between the expecting change in organization and organizational commitment, leave attitude, work satisfaction, service attitude.

4. The employees that have personality of self-control are evidently interfered by the job insecurity that is derived from variation on work scenario, variation on opportunity of employment, variation on management pattern of organization and variation on work character. The employees that have personality of extraversion are evidently interfered by the job insecurity that is derived from variation on structure of human resource and variation on work character.

第一章 緒論
第一節 研究動機與研究目的……………………………… 1
第二節 研究目的………………………………………… …3
第三節 研究流程………………………………………… …4
第二章 文獻探討
第一節 醫療產業的特性………………………………………5
第二節 工作之不安全感………………………………………7
第三節 預期組織改變對於工作不安全感之影響………… 11
第四節 工作不安全感對於員工作態度之影響………………16
第五節 人格特質之內外控取向………………………………24
第三章 研究方法
第一節 研究架構………………………………………………26
第二節 研究變項之衡量………………………………………27
第三節 研究對象與資料蒐集與樣本特性分析………………40
第四節 分析方法………………………………………………43
第五節 修正後之研究架構與研究假設………………………45
第四章 研究結果
第一節 研究變項現況分析……………………………………47
第二節 各研究變項間相關分析………………………………55
第三節 各相關變項之影響性分析與探討……………………62
第四節 工作不安全感對於預期組織改變與員工………… 69
工作態度變項之間關係的中介效果檢定
第五節 工作不安全感與員工工作態度變項受干………… 72
擾變項之影響檢定
第五章 結論與建議
第一節 研究結果………………………………………………82
第二節 管理實務討論…………………………………………93
第三節 研究限制………………………………………………96
參考文獻…………………………………………………………97
附錄 研究問卷

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