臺灣博碩士論文加值系統

本研究旨在以質性研究方式探討參與家庭醫師整合性照護試辦計畫之基層診所加入社區醫療群及影響醫療群合作之因素，藉此研究期望能對現今實施家醫計畫推廣有所建議，並能完善地貼近診所的需求 根據高醫翡翠醫療群，合作之基層診所為本研究對象，共計5家基層診所參與本研究進行質性深入訪談。
首先，從個體觀點談論加入社區醫療群的原因，主因是為了配合政府政策，各診所期待加入醫療群後能獲得更多的政府資源。各院長對於策略聯盟夥伴的選擇必具備條件：1. 高層有良好的決策。2. 有良好的服務品質。3. 有良好的顧客口碑。4. 有良好的整體聲譽。5. 與顧客關係不錯。6. 有互補性，可學習新知識。探討其背後的主因素，能使診所能夠持續獲利及永續經營，是院長們最重要的考量。其次，從訪談中院長們認為策略聯盟模成功要素為：1. 互惠:彼此能夠長期支援，使雙方均蒙受利益。2. 績效評估:多半採用彼此相互校閱的方式，而非直接評量諉過。 3. 合作夥伴遇到問題時，會主動幫忙。4. 合作夥伴間並不會斤斤計較誰付出的多或少。5. 誠信:是最具代表性的因素，最不需要彼此監督的合作方式，可望藉由彼此不斷的信賴參與獲取利潤，限制機會主義的產生與彼此的不信任。6.當問題發生，會被視為是共同的問題且不會互踢皮球。7. 合作夥伴在合作中是有彈性的，不會彼此束縛。
最後，對診所策略聯盟推動有以下三項的建議 ：1.資訊更透明：群組秘書更主動聯繫與提供階段性目標達成情況 ，將聯盟管理中心的角色視為協助與整合會員的幫助角色，而非是一般對內進行管理事務的「內部管理中心」。如此會有助於聯盟的運作，使內部的溝通更加順暢。2.更好的科技能力：聯盟管理中心可以與專業組織合作，不但可以提高服務品質，也可以縮短學習時間，減少無形的運作成本。3.更完整的運作制度：推動聯盟的程序與步驟 任何一件事要能夠順利推動，程序與步驟是十分重要的。除了了解成功的因素外，也應該要注意推動聯盟的順序，尤其是在進行聯盟建立的初期時，一定要先從共信與共識的建立開始。而完善的制度正是建立共信共識的基礎要件。

The purpose of this research is to explore the factors that affect the cooperation of community medical groups by primary clinics participating in the pilot program of integrated care of family doctors in a qualitative way, so as to hope that the research can contribute to the promotion of the current implementation of family doctors. Suggestions, and can be perfectly close to the needs of clinics. According to the high-tech Jade Medical Group, the cooperative primary clinics are the research objects, and a total of 5 primary clinics participated in this research to conduct qualitative in-depth interviews.
First of all, discuss the reasons for joining the community medical group from an individual point of view. The main reason is to cooperate with government policies. Clinics expect to receive more government resources after joining the medical group. The deans must have the following conditions for the selection of strategic alliance partners: 1. Good decision-making at the top. 2. Have good service quality. 3. Have a good customer reputation. 4. Have a good overall reputation. 5. Good relationship with customers. 6. Complementary, can learn new knowledge. Discussing the main factors behind it is the most important consideration for the directors to enable the clinic to continue to profit and operate in a sustainable manner. Secondly, from the interviews, the deans believe that the successful factors of the strategic alliance model are: 1. Reciprocity: long-term support for each other, so that both parties can benefit. 2. Performance appraisal: Most of them use mutual review instead of direct assessment. 3. When partners encounter problems, they will take the initiative to help. 4. Partners do not care about who pays more or less. 5. Integrity: is the most representative factor, the least need to supervise each other's cooperation method, it is expected that through mutual trust and participation to obtain profits, limit the generation of opportunism and mutual distrust. 6. When a problem occurs, it will be regarded as a common problem and will not kick the ball. 7. Partners are flexible in cooperation, and will not bind each other.
Finally, there are three suggestions for the promotion of the clinic strategic alliance: 1. More transparent information: the group secretary is more proactive in contacting and providing the status of the achievement of phased goals, and the role of the alliance management center is regarded as the role of assisting and integrating members. It is not an "internal management center" for general internal management. This will help the operation of the alliance and make internal communication smoother. 2. Better technological capabilities: The alliance management center can cooperate with professional organizations, which can not only improve service quality, but also shorten learning time and reduce intangible operating costs. 3. A more complete operating system: procedures and steps to promote the alliance. The procedures and steps are very important for any thing to be promoted smoothly. In addition to understanding the factors of success, we should also pay attention to the order of promoting the alliance, especially in the initial stage of alliance establishment, we must first start with the establishment of mutual trust and consensus. A perfect system is the basic requirement for establishing mutual trust and consensus.

目錄
中文摘要 ............................................................................................................................. i
英文摘要 ............................................................................................................................iii
致 謝 ...................................................................................................................................v
目 錄.....................................................................................................................................vi
表目錄 .............................................................................................................................viii
圖目錄 ................................................................................................................................ix
第一章 緒論 .......................................................................................................................1 1.1
研究背景及動機 .........................................................................................................1 1.2
研究動機 ......................................................................................................................2
1.3 研究流程 ......................................................................................................................4
第二章 文獻探討 ..............................................................................................................6
2.1策略聯盟 .....................................................................................................................6
2.1.1策略聯盟的動機.........................................................................................................6
2.1.2策略聯盟的形成..........................................................................................................7
2.1.3策略行為理論..............................................................................................................8
2.1.4資源依賴理論 ............................................................................................................8
2.1.5組織學習理論 ............................................................................................................9
2.2策略聯盟商業模式關鍵成功因素 ..................................................................................10
2.2.1關鍵成功因素定義....................................................................................................10
第三章 研究方法..............................................................................................................24
3.1研究方法.......................................................................................................................24
3.1.1質化研究方法............................................................................................................24
3.1.2菁英訪談法.........................................................................................................24
3.1.3標準化開放式訪談...................................................................................................25
3.1.4資料搜集方式............................................................................................................25
3.1.5研究信度及效度........................................................................................................25
3.2. 研究參與者.................................................................................................................26
3.2.1研究者本身................................................................................................................26
3.2.2研究對象....................................................................................................................27
3.2.3研究工具....................................................................................................................28
第四章 個案描述與分析..................................................................................................33
4.1家庭醫學介紹........................................................................................................33
4.1.1家庭醫學歷史沿革...................................................................................................33
4.1.2家庭醫學的內涵........................................................................................................36
4.1.3基層醫療變革及現狀................................................................................................37
4.2個案聯盟分析...............................................................................................................38
4.2.1個案醫療群成立緣由...............................................................................................38
4.3個案聯盟成功因素.....................................................................................................39
4.3.1聯盟加入動機...........................................................................................................39
4.3.2聯盟夥伴的選擇需具備的條件..............................................................................41
4.3.3聯盟合作成功的關鍵因素.......................................................................................43
4.3.4醫療聯盟管理運作的現況.......................................................................................45
4.3.5醫療聯盟的品牌經營的現況...................................................................................47
第五章 結論與建議..........................................................................................................49
5.1研究結論.......................................................................................................................49
5.1.1診所策略聯盟夥伴的選擇必具備條件.................................................................49
5.1.2診所策略聯盟模式成功要素..................................................................................50
5.2對策略聯盟及醫師的建議........................................................................................50
5.2.1對診所策略聯盟推動的建議..................................................................................50
5.2.2對診所醫師的建議...................................................................................................51
5.3研究限制.......................................................................................................................52
5.4 後續研究之建議..........................................................................................................53
參考文獻.............................................................................................................................54
附錄......................................................................................................................................67

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