醫院導入學習型組織的變革模式探討－以某地區教學醫院為例

An Organizational Change Model of a Hospital Initiated by a Learning Organization: A Case Study in a Community Teaching Hospital

10.6288/TJPH2008-27-05-07

蘇崑山(Kun-Shan Kun)；李昭華(Chao-Hua Li)；楊遠誠(Yuan-Cheng Yang)

學習型組織 ； 組織變革 ； learning organization ； organizational change

台灣公共衛生雜誌

27卷5期（2008 / 10 / 01）

421 - 433

繁體中文

目標：探討醫院導入學習型組織，以促動組織變革的模式為何？並歸納出哪些行動對於誘導變革朝向預定目標有幫助？方法：我們將研究個案長達六年多來推動學習型組織的學習歷史，透過訪談稿、觀察記錄及會議記錄，多方面資料的質性分析來探討。結果：一、醫院能夠持續推動學習型組織並促使組織變革轉型的原因，是來自於變革小組組成實踐社群的先導群，且推動的目的能順應組織階段的需求，達成組織階段的目標。二、並以專案式的團隊學習模式，發展學習型組織的核心能力，作為組織發展再轉型的能量，促使組織的變革轉型。三、在醫院組織變革的過程中，醫院導入學習型組織工具與新的學習架構，與醫院的脈絡(contexts)互動後，產生出阻力和助力，而促使變革經歷轉型，所遇的變革挑戰來自於變革代理人需調適轉型的成效和阻力，使變革活動和組織的願景相結合，產生出醫院品質管理的組織績效。結論：藉由調適，學習，再轉型的過程模式，個案能持續應用學習型組織的理論於實務，逐步邁向學習型組織。

Objectives: To explore an organizational change model of a hospital initiated by a Learning Organization (LO), and to induce factors that will facilitate the fulfillment of both short-term goals and long-term visions. Methods: A longitudinal case study was implemented at a hospital that had six years of prior interactions with a LO, and qualitative data analysis was performed on the learning history, interview transcripts, observation notes and meeting records. Results: (1) The continuation of a LO is due to the steering committee's practice of alignment between the promotion of the LO and the organizational goals. (2) Then, the learning capacity of a LO is expanded through team-learning projects, which promote organizational development and the shift of organizational change to different phases. (3) In the transformational process, difficulties are encountered because the facilitators must face impediments arising from interactions between new organizational learning tools and organizational contexts. A necessary task is for change agents to monitor the periodic effects of change and ensure that the change activities meet the demands of medical quality control, so that change can be compatible with an organization's mission and performances. Conclusions: The process model of adaptation, learning, and re-transformation calls for the continuous application of the LO concept to the hands-on practices of a hospital and makes a learning organization accessible.

1. Argyris C,Schon D(1996).An Organizational Learning II: Theory, Method and Practice.MA:Addison-Wesley.
2. Burke WW,Litwin GH(1992).A causal model of organizational performance and change.J Manage,18,523-545.
3. de Bono E(1992).Serious Creativity: Using the Power of Lateral Thinking to Create New Ideas.London:Harper Collins.
4. McCann JE(1991).Patterns of growth, competitive technology, and financial strategies in young ventures.J Bus Venturing,6,189-208.
5. Montuori LA(2000).Organizational longevity: integrating systems thinking, learning and conceptual complexity.J Organ Change Manag,13,61-73.
6. Ortenblad A(2002).A typology of the idea of learning organization.Manag Learn,33,213-230.
7. Senge PM(1990).The Fifth Discipline: The Art and Practice of the Learning Organization.New York:Doubleday Currency.
8. Senge PM,郭進隆(譯)(1994).第五項修練.台北:天下文化.
9. Senge PM,廖月娟,陳琇玲,李芳齡(譯)(2001).第五項修練Ⅲ變革之舞.台北:天下文化.
10. Tsoukas H,Chia R(2002).On organizational becoming: rethinking organizational change.Organ Sci,13,567-582.
11. Wenger E,McDermott R,Snyder WM,黃維(譯)(2003).實踐社群.台北:天下文化.