以醫學倫理與顧客價值觀點探討醫院產業服務創新價值創造之演進

Exploring Evolution of Value Creation by Service Innovations in Hospital Industry Based on the Perspective of Medical Ethics and Customer Value

10.6504/JOM.2012.29.05.04

邱文宏(Wen-Hong Chiu)；朱立聖(Li-Sheng Chu)；紀慧如(Hui-Ru Chi)；張元杰(Yuan-Chieh Chang)；張益彰(I-Chang Chang)；張碧如(Bi-Ru Chang)

服務創新 ； 醫學倫理 ； 顧客價值 ； 價值創造 ； 價值演進 ； Service Innovation ； Medical Ethics ； Customer Value ； Value Creation ； Value Evolution

管理學報

29卷5期（2012 / 10 / 01）

489 - 512

繁體中文

本研究之醫學倫理與顧客價值五大觀點為倫理價值、功能性價值、快樂性價值、關係性價值與情境性價值，採單一產業個案導向之質性研究方法，個案對象共篩選60家，透過次級資料與深度訪談共蒐集536件創新事件，依類型比對、解釋建構、時間序列分析、以及程序邏輯模式進行資料分析。本文獲得四項研究發現：一、價值創造以功能性價值為核心，情境性價值與關係性價值為輔。二、醫院層級越高對功能性價值越重視，而層級越低對關係性價值越重視。三、醫院功能性價值於各階段比例呈遞減趨勢，反觀關係性價值呈上升趨勢；情境性價值呈U型演進，而倫理價值與快樂性價值則呈倒U型演進。四、醫院層級高者所提供創新事件數於各階段比例呈大幅遞減趨勢，而層級低者則呈大幅上升趨勢。

The perspective consisting of medical ethics and customer value concerns five: ethical value, functional value, hedonic value, relational value and contextual value. This study adopts a single-industry case-oriented qualitative research method. A total of 60 hospitals were selected. Through secondary data collection and in-depth interviews, this study totally collected 536 innovation events. The data analysis is based on the methods of pattern-matching, explanation-building, time-series and program logic model. The findings are: 1. The core value creation by service innovations is ”functional value”, supplemented by ”contextual value” and ”relationship value”. 2. The hospitals with higher hierarchy pay more attention to ”functional value”, while the hospitals with lower hierarchy pay more attention to ”relationship value”. 3. The rate of innovation events creating ”functional value” shows a declined trend, while that creating ”relationship value” shows an increasing trend; the rate of innovation events creating ”contextual value” shows an U-type curve, while that creating ”ethical value” or ”hedonic value” shows an inversed U-type. 4. The rate of innovation events provided by the hospitals with higher hierarchy shows a declined trend, while that provided by the hospitals with slower hierarchy shows an increasing trend.

1. 范惟翔、張瑞鉉、謝惠蓉(2008)。保險商品核心利益、企業形象與顧客價值對顧客承諾之影響關係研究。顧客滿意學刊，4(1)，35-68。
   連結：
2. 翁瑞宏、邱柏松、蔡文正、黃靖媛(2007)。以知識基礎觀點探討聯盟網絡多元性對醫院組織創新之影響。管理學報，24(5)，485-513。
   連結：
3. 張嘉雯、王惠玄、詹又諳(2010)。病患參與醫療服務的前置因素及後續行為之探討：以一般外科為例。管理學報，27(6)，603-621。
   連結：
4. 陳瑞容(2002)。台灣醫療產業的組織合作：不對等合作關係運作機制之探討。台灣社會學，3，119-162。
   連結：
5. 羅萱(2007)。追求卓越─體制力量與管理創新：台灣醫療產業之實證研究。管理學報，24(5)，515-529。
   連結：
6. Babin, B. J.,Darden, W. R.,Griffin, M.(1994).Work and/or Fun: Measuring Hedonic and Utilitarian Shopping Value.Journal of Consumer Research,20(4),644-656.
7. Baker, S. M.,Kleine, S. S.,Bennion, M.(2003).What Do They Know? Integration the Core Concept of Customer Value into the Undergraduate Marketing Curriculum and Its Assessment.Journal of Marketing Education,25(1),79-89.
8. Beauchamp, T. L.,Childress, J. F.(2001).Principles of Biomedical Ethics.NY:Oxford University Press.
9. Borstel, G.(1956).Ownership, Competition and Comment in 20 Small Dailies.Journalism Quarterly,33(2),220-222.
10. Breuer, F.,Mruck, K.,Roth, W. M.(2002).Subjectivity and Reflexivity: An Introduction.Forum Qualitative Social Research/Forum Qualitative Sozialforschung,3(3),1-9.
11. Chandon, P.,Wansink, B.,Laurent, G.(2000).A Benefit Congruency Framework of Sales Promotion Effectiveness.Journal of Marketing,64(4),65-81.
12. Chinho, L.,Chienwen, H.(2008).Using Customer Knowledge in Designing Electronic Catalog.Expert Systems with Applications,34(1),119-127.
13. Court, D.,French, T. D.,Mcguire, T. I.,Partington, M.(1999).Marketing In 3-D.The Mckinsey Quarterly,4(1),6-17.
14. Damanpour, F.,Walker, R. M.,Avellaneda, C. N.(2009).Combinative Effects of Innovation Types and Organizational Performance: A Longitudinal Study of Service Organizations.Journal of Management Studies,46(4),650-675.
15. Day, G. S.(1994).The Capabilities of Market-Driven Organization.Journal of Marketing,58,37-52.
16. Dearing, J. W.,Rogers, E. M.(1996).Communication Concepts 6: Agenda-Setting.Thousand Oaks, CA:Sage.
17. Demonaco. H. J.,Ali, A.,von Hippel, E.(2006).The Major Role of Clinicians in the Discovery of Off-Label Drug Therapies.Pharmacotherapy,26(3),323-332.
18. den Hertog, P.,Broersma, L.,van Ark, B.(2003).On the Soft Side of Innovation: Service Innovation and Its Policy Implications.De Economist,151(4),433-452.
19. Dillon, T. A.,Lee, R. K.,Matheson, D.(2005).Value Innovation: Passport to Wealth Creation.Research-Technology Management,48(2),22-36.
20. Djellal, F.,Gallouj, F.(2001).Patterns of Innovation Organization in Service Firms: Portal Survey Results and Theoretical Models.Science and Public Policy,28(1),57-67.
21. Downs, A.(1991).Lawrence, KS,University of Kansas.
22. Dube, C.,Nozaki, I.,Hayakawa, T.,Kakimoto, K.,Yamada, N.,Simpungwe, J. B.(2010).Expansion of Antiretroviral Treatment to Rural Health Center Level by a Mobile Service in Mumbwa District, Zambia.Bulletin of the World Health Organization,88(10),788-791.
23. Eurostat(1995).Report of the Eurostat Pilot Project to Investigate the Possibilities to Measure Innovation in the Service Sectors.Luxemburg:Eurostat.
24. Fasano, P.(2010).Health Care Innovation.Issues in Science & Technology,27(2),9-11.
25. Flint, D. J.,Woodruff, R. B.,Gardial, S. F.(2002).Exploring the Phenomenon of Customers' Desired Value Change in a Business-to-Business Context.Journal of Marketing,66(October),102-117.
26. Gale, B. T.(1994).Managing Customer Value.New York:Free Press.
27. Gallouj, F.,Weinstein, O.(1997).Innovation in Services.Research Policy,26(4-5),537-556.
28. Ghemawat, P.,Collis, D.,Pisano, G.(1999).Strategy and the Business Landscape: Core Concepts.New York:Prentice Hall.
29. Gillon, R.(1994).Medical Ethics: Four Principles plus Attention to Scope.British Medical Journal,309(3),184-188.
30. Gruber, J.(2009).Technical Assistance for Health in Non-Conflict Fragile States: Challenges and Opportunities.The International Journal of Health Planning and Management,24(2),S4-S20.
31. Gustafsson, A.,Johnson, M.(2003).Competing in a Service Economy: How to Create a Competitive Advantage through Service Development and Innovation.San Francisco:Jossey-Bass.
32. Hall, R.(1992).The Strategic Analysis of Intangible Resources.Strategic Management Journal,13(3),135-144.
33. Holbrook, M. B.(2006).Consumption Experience, Customer Value, and Subjective Personal Introspection: an Illustrative Photographic Essay,.Journal of Business Research,59(5),714-725.
34. Holm, D. B.,Eriksson, K.,Johnson, J.(1996).Business Networks and Cooperation in International Business Relationships.Journal of International Business Studies,5(Special Issue),1033-1053.
35. Honderic, T.(1995).The Oxford Companion to Philosophy.New York:Oxford University Press.
36. Jackson, T. W.(2007).Customer Value Exchange.Journal of Financial Service Marketing,11(6),314-332.
37. Leiponen, A.(2005).Organization of Knowledge and Innovation: The Case of Finnish Business Services.Industry and Innovation,12(2),185-203.
38. Lichtman, M.(2006).Qualitative Research in Education: A User's Guide.Thousand Oaks, CA:Sage.
39. Lin, C. A.(1995).Diversity of Network Prime-Time Program Formats during the 1980s.Journal of Media Economics,8(4),17-28.
40. Maffei, S.,Mager, B.,Sangiorgi, D.(2005).Innovation through Service Design: From Research and Theory to a Network of Practice, a User's Driven Perspective.International Conference on Design Research,Finland:
41. Mansury, M. A.,Love, J. H.(2008).Innovation, Productivity and Growth in US Business Services: A Firm-Level Analysis.Technovation,28(1),52-62.
42. McCombs, M.,Shaw, D.(1972).The Agenda Setting Function of Mass Media.Public Opinion Quarterly,36(2),176-187.
43. Miles, I.(1996).Innovation in Service, Service in Innovation.Manchester:Manchester Statistics Society.
44. Miller, R.,Olleros, X.(2008).To Manage Innovation Learn the Architecture.Research-Technology Management,51(3),17-27.
45. Ming, M.,Li, Z.,Chen, J.(2008).Phase-Type Distibution of Customer Relationship with Markovian Response and Marketing Expenditure Decision on the Customer Lifetime Value.European Journal of Operational Research,187(1),313-326.
46. Möller, K.(2006).Role of Competences in Creating Customer Value: A Value-Creation Logic Approach.Industrial Marketing Management,35(8),913-924.
47. Moller, K.,Rajala, R.,Westerlund, M.(2008).Service Innovation Myopia?: A New Recipe for Client-Provider Value Creation.California Management Review,50(3),31-48.
48. Moseley, C. B.,Shen, J. J.,Ginn, G. O.(2011).Characteristics of Acute Care Hospitals with Diversity Plans and Translation Services.Journal of Healthcare Management,56(1),45-61.
49. Naimoli, J. F.(2009).Global Health Partnerships in Practice: Taking Stock of the GAVI Alliance's New Investment in Health Systems Strengthening.The International Journal of Health Planning and Management,24(1),3-25.
50. Nyland, K.,Pettersen, I. J.,Östergren, K.(2009).Same Reform - Different Practices?: How Regional Health Enterprises Adjust to Management Control Reforms.Journal of Accounting & Organizational Change,5(1),35-61.
51. O''Sullivan, J. P.,Jacinta, G. P.,Emmerson, B.(2009).The Resource Hub: An Innovative E-Information Service Delivery Model Addressing Mental Health Knowledge Management.Australasian Psychiatry,17(5),371-374.
52. Overby, J. W.(2005).An Integrative Review of Customer Value Management and National Culture: France and the United States.International Journal of Management,22(2),166-175.
53. Paton, R. A.,McLaughlin, S.(2008).Service Innovation: Knowledge Transfer and the Supply Chain.European Management Journal,26(2),77-83.
54. Porter, M. E.(1980).Competitive Strategy.New York:Free Press.
55. Reeder, L. G.(1972).The Patient-Client as a Consumer: Some Observations on the Changing Professional-Client Relationship.Journal of Health and Social Behavior,13(4),406-412.
56. Roper, K.(2003).A Strategic Cornerstone-Defining and Measuring Customer Value.Journal of Construction Accounting and Taxation,1(1),24-30.
57. Rust, R. T.,Zeithaml, V. A.,Lemon, K. Z.(2001).What Drives Customer Equity.Marketing Management,10(1),20-25.
58. Schneiderman, L. J.(2000).Alternative Medicine or Alternatives to Medicine? A Physician's Perspective.Camb Q Healthc Ethics,9(3),83-97.
59. Shelton, R.(2009).Integrating Product and Service Innovation.Research-Technology Management,52(3),38-44.
60. Skiba, F.,Herstatt, C.(2009).Users as Sources for Radical Service Innovations: Opportunities from Collaboration with Service Lead Users.International Journal of Services Technology & Management,12(3),317-337.
61. Spath, D.,Fahnrich, K. P.(2007).Advances in Service Innovations.Berlin:Springer.
62. Tether, B. S.(2005).Do Services Innovate (Differently)? Insights from the European Innobarometer Survey.Industry and Innovation,12(3),153-184.
63. Thielke, T. S.(2010).Synergistic Relationship between Pharmacy Leadership Development and Pharmacy Service Innovation.American Journal of Health-System Pharmacy,67(10),815-820.
64. Treacy, M.,Wiersema, F.(1995).The Discipline of Market Leaders.Reading, MA:Addision-Wesley.
65. von Hippel, E.,Oliveira, P.(2009).Users as Service Innovators: The Case of Banking Services, Working Paper.Cambridge, MA:MIT Sloan School of Management.
66. Wei, R.(2008).Motivations for Using the Mobile Phone for Mas Communications and Entertainment.Telematics and Informatics,25(1),36-46.
67. Weinstein, A.(2002).Customer-Specific Strategies Customer Retention: a Usage Segmentation and Customer Value Approach.Journal of Targeting, Measurement and Analysis for Marketing,10(3),259-268.
68. Woodruff, R. B.(1997).Customer Value: The Next Source of Competitive Advantage.Journal of the Academy of Marketing Science,25(2),139-153.
69. Yin, R. K.(1994).Case Study Research: Design and Methods.Thousand Oaks, CA:Sage.
70. 吳孟寧(2007)。由媒體議題設定功能探討卡奴條款之政策發展。T&D飛訊，58，1-16。
71. 李秀珠(2002)。新傳播科技與媒體市場之經營管理。台北:廣電基金會。
72. 李明濱(2010)。從推動專業自主到提升醫療品質。台灣醫界，53(3)，111-112。
73. 李勝祥(2003)。全民健保影響醫院組織文化與經營績效之研究。高雄海院學報，18，289-303。
74. 林義鈜(2008)。論醫學倫理教育。澄清醫護管理雜誌，4(4)，4-7。
75. 邱文達、石崇良、侯勝茂(2004)。病人安全與醫學倫理─建構以病人為中心的醫療體系。臺灣醫學人文學刊，五(一、二)，66-96。
76. 侯英男(2006)。健保問題的省思。財團法人台灣醫療改革基金會會訊，13，17-20。
77. 紀櫻珍、紀琍琍、吳振龍、黃松元(2006)。醫學倫理與醫病關係。北市醫學雜誌，3(12)，1144-1154。
78. 徐永明(2001)。事件與議題─台灣2000年總統選舉中的興票案與兩岸關係。民意研究季刊，215，67-97。
79. 紐則誠(2004)。生命教育─倫理與科學。台北:揚智文化。
80. 莊茂(2000)。台灣病人人權之研究。台灣醫學人文學刊，1(1)，86-101。
81. 陳映燁、李明濱(2000)。醫學倫理之理論與原則。醫學教育，4(1)，3-22。
82. 陳曉萍、徐淑英、樊景立、鄭伯壎(2008)。組織與管理研究的實證方法。台北:華泰文化事業。
83. 黃雅琳、孫智麗(2005)。台灣醫療產業結構與發展趨勢。台灣經濟研究月刊，28(2)，1-10。
84. 黃達夫(1999)。用心聆聽─黃達夫改寫醫病關係。台北:天下遠見出版。
85. 載正德(2000)。醫學倫理導論。台北:教育部。
86. 載正德(2001)。病人為中心的倫理思維。健康世界，186，93-97。
87. 臧國仁(1999)。新聞媒體與消息來源：媒介框架與事實建構之論述。台北:三民。
88. 蔡文展(2007)。談醫學倫理教育。醫療品質雜誌，1(3)，19-21。
89. 蔡甫昌、黃獻樑、陳彥元(2007)。病患要求施行輔助及另類療法所涉醫學倫理問題。台灣醫學，11(1)，91-103。
90. 戴正德(2004)。基礎醫學倫理學。新北:高立圖書有限公司。

1. 胡倇綨(2016)。客戶服務與退貨改善策略分析-以X公司為例。淡江大學國際企業學系碩士在職專班學位論文。2016。1-89。