醫院策略執行對醫師同理心之影響：跨層次分析

The Effect of Hospital Strategy Implementation on Physicians' Empathy: A cross-level Analysis

10.6288/TJPH2010-29-06-02

汪秀玲(Hsiu-Ling Wang)；關皚麗(Aij-Lie Kwan)；黃俊英(Jun-Ying Huang)

策略執行 ； 同理心 ； 系絡變項 ； 跨層次研究 ； 層級線性模型 ； strategy implementation ； empathy ； contextual variable ； cross-level research ； hierarchical linear modeling

台灣公共衛生雜誌

29卷6期（2010 / 12 / 01）

487 - 502

繁體中文

Objectives: This study explored the contextual effects of a perceived emphasis on cost and revenue on physicians' empathy in hospitals participating in the global budget program. Methods: We selected 84 teaching hospitals and surveyed 1, 280 physicians with structured questionnaires. A total of 441 usable questionnaires from 51 hospitals were returned. This represented response rates of 60.71 percent for the hospitals and 34.45 percent for the physicians. We conducted hierarchical linear modeling using individual physician-evaluated empathy as the outcome variable. The perceptions of strategic implementation at the physician level were aggregated at the hospital level to serve as a contextual variable. We also included rank, ownership and religious type as hospital-level variables. Results: The strategy of revenue-generation led to increases in physicians' compassionate care and perspective taking (γ=0.249, 0.150, p＜.05), but unit management's emphases on cost containment did not significantly reduce physicians' empathy (γ=-0.054~-0.109, p＞.05). The contextual effects of hospital rank (medical centers vs. regional hospital) on physicians’ compassionate care (γ=0.20, p＜.05) as well as ownership (public vs. private) on physicians’ perspective taking (γ=0.208, p＜.05) showed significant differences, although the contextual effects of religious type were not significant (γ=0.019~0.202, p＞.05). Physician age positively influenced physician empathy in compassionate care (γ=0.070, p＜.05); however, data revealed no significant differences among medical specialties (γ=-0.057~0.051, p＞.05). The individual-level factors explained 26.77%~32.93% of within-hospital variance on empathy and hospital-level factors explained 45.49%~59.33% of between-hospital variance. Conclusions: Results indicated that organization context could shape the physicians' empathy, while the impact of personal characteristics should not be ignored.

Objectives: This study explored the contextual effects of a perceived emphasis on cost and revenue on physicians' empathy in hospitals participating in the global budget program. Methods: We selected 84 teaching hospitals and surveyed 1, 280 physicians with structured questionnaires. A total of 441 usable questionnaires from 51 hospitals were returned. This represented response rates of 60.71 percent for the hospitals and 34.45 percent for the physicians. We conducted hierarchical linear modeling using individual physician-evaluated empathy as the outcome variable. The perceptions of strategic implementation at the physician level were aggregated at the hospital level to serve as a contextual variable. We also included rank, ownership and religious type as hospital-level variables. Results: The strategy of revenue-generation led to increases in physicians' compassionate care and perspective taking (γ=0.249, 0.150, p＜.05), but unit management's emphases on cost containment did not significantly reduce physicians' empathy (γ=-0.054~-0.109, p＞.05). The contextual effects of hospital rank (medical centers vs. regional hospital) on physicians’ compassionate care (γ=0.20, p＜.05) as well as ownership (public vs. private) on physicians’ perspective taking (γ=0.208, p＜.05) showed significant differences, although the contextual effects of religious type were not significant (γ=0.019~0.202, p＞.05). Physician age positively influenced physician empathy in compassionate care (γ=0.070, p＜.05); however, data revealed no significant differences among medical specialties (γ=-0.057~0.051, p＞.05). The individual-level factors explained 26.77%~32.93% of within-hospital variance on empathy and hospital-level factors explained 45.49%~59.33% of between-hospital variance. Conclusions: Results indicated that organization context could shape the physicians' empathy, while the impact of personal characteristics should not be ignored.

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