員工對組織變革的認知與組織承諾之關係
－以公立醫院改制為例
政府推動公立醫院多元化經營，期望公立醫院能透過此過程，進行體質改變和組織調整，脫離舊有的經營管理模式，
成為創造高品質及高效能之醫療機構，並兼顧公共醫療之目的。
署立雲林醫院改制為某醫學中心雲林分院是公立醫院多元化經營的一種類型，改制是組織變革的一種，過程中改制之 衝擊難免。某醫學中心雲林分院改制後 3 年來，相關數據均顯示經營績效已大幅提升。 Kushman(1992) 認為組織承諾 和組織績效呈正相關，「人的問題」是組織變革中成功與否的關鍵所在。因此本研究旨在探討某醫學中心雲林分院員 工對醫院改制的組織變革認知及組織承諾，並試圖瞭解組織變革認知對組織承諾之影響。
本研究採用結構式問卷進行，於民國 96 年 4 月至 5 月間進行施測，研究對象原設定為醫院改制前（民國 93 年 4 月 1 日）到職之所有員工，因考量發放問卷時，有些員工需答覆問卷，有些員工無需回答問卷，會造成員工不願表達真實 感受，故問卷發放對象訂為民國 96 年 3 月 1 日所有在職員工，以普查方式進行問卷調查。共發出 867 份問卷，回收有 效問卷 804 份，回收率達 92% 。
本研究之研究結果顯示，歷經醫院改制組織變革之員工（即改制前到院的員工），其溝通協調認知與營運效益認知對 情感性承諾、持續性承諾、規範性承諾均有顯著正相關；在個人權益認知的部分，則與情感性承諾及規範性承諾呈現 顯著正相關。
由複迴歸分析結果得知，對於溝通協調認知、營運效益認知及個人權益認知越高者，其情感性組織承諾越大；對於營 運效益認知越高者，其持續性組織承諾越高；溝通協調認知越高及個人權益認知越高者者，其規範性組織承諾越高。
改制前到院員工之情感性承諾、持續性承諾及規範性承諾等三構面之平均值均高於改制後到院員工，且二組之平均數 均皆偏向正面。在改制前到院員工方面，得分依序為「情感性承諾」、「持續性承諾」及「規範性承諾」；在改制後 到院員工方面，得分依序為「情感性承諾」、「規範性承諾」及「持續性承諾」。顯示不論是改制前到院的員工或是 改制後才到院的員工，都擁有強烈的情感性承諾而想要留在目前之醫院。在員工的個人變項對於組織承諾的影響方面
，年齡和年資與組織承諾都有關，愈年長及服務年資愈久的員工，對組織的承諾較強。
員工的個人變項對於組織變革之認知的影響方面，組織變革認知的得分依序為「營運效益」、「溝通協調」及「個人 權益」，顯示員工最認同組織變革後之營運效益，且對「醫院改制後，競爭能力已提升」之得分最高，而員工的認知 與醫院客觀營運績效是相互呼應的。員工的個人變項中，年齡部份、婚姻狀況、職位及職別與組織變革認知都有關，
年長者、主管有較好之變革認知，且在「溝通協調認知」及「營運效益認知」有顯著差異。編制內公務人員在組織變 革認知三個構面之平均分數均高於約聘或約雇人員及院聘人員二組，且三個構面均有顯著差異。
個案醫院在改制為某醫學中心雲林分院之後，依據國內數個有關個案醫院相關研究結果顯示，該醫院不僅在客觀的營 運效益及財務狀況有顯著改善，且從本研究的結果來看，個案醫院員工在改制後對組織變革的認知與對組織的承諾均 有相當正向的評價，顯示員工對於改制後的組織有著高度的認同感。政府近年來致力推動公立醫院多元化經營，以本 個案而言，顯然具有相當成效。相信個案醫院的績效表現及本研究的調查結果，對於未來政府在考量持續推動公立醫 院多元化經營時，將會是一項鼓舞與肯定，也可能因此將帶動其他署立醫院變革的意願與動力，為台灣中型公立醫院 的經營困境，帶來一股全新的變革前景。
Relationships between Employees’ Perceptions of Organizational Changes and Organizational Commitment － A Case Study on the
Process of
Changing Affiliation in a Public Hospital
The Taiwan government has implemented a policy to reform the public hospitals in order to meet requirements of new era, ho wever, changing subordination of an organization usually comes up against resistance of its employees. Three years ago, the Yun-Lin Hospital of Department of Health was remodeled and changed subordination as the Yun-Lin Branch of National Tai wan University Hospital. Several case studies have proved that changing subordination of this hospital successfully improves the working performance and solved the financial problems. The policy of reforming public hospitals is promising.
As human resource, especially the employee’s devotion to the organization, is the most important key successful factor in org anizational performance, the present study aims to investigate the relations between the employee’s cognition of organization changes (the dependent variable; including working performance, communication/negotiation, and personal right) and the org anization commitment to its employees (the independent variable; including the emotional, persevering, and normative commi tments). It also aims to understand how the independent variables affect the dependent ones.
The investigation was carried out in April and May 2007. A well-designed structural questionnaire was delivered to each staff hired before April 2007. A high recover rate (92%) was obtained. Employees who had undergone the remodel process of this hospital have a good relation between their cognitions in organization changes and the organizational commitments. A multi-r egression analysis revealed a positive relationship between the scores of dependent variables and those of the dependent varia bles. A careful comparison was made on the effects of personal variables on the 3 aspects of the independent variables, betwe en the two groups of employees hired before and hired after hospital remodeling. Both groups of employees have strong willi ng to stay at the present working place, though the median score of each independent variable is higher in those having experi enced remodeling than those not experienced. Further analysis of the effects of personal variables (age, marriage, occupation position) on organizational change cognition showed that senior staffs, married employees and the section/department chiefs h ave better cognition in organizational changes and better perception in organizational commitments. Employees specified in t he organic law have higher scores in the 3 aspects of the independent variables than in the on-contract workers.
In conclusion, the present study proves that a positive attitude towards the organization changes does exist in the employee. T hey perceived the organization commitments and responded to organization changes positively. They strongly supported the p olicy of hospital remodeling. Such strong support is believed playing an important major role in performance achievement aft er hospital remodeling.
