| 摘要: | 在知識密集的醫療產業中，醫師的知識及專業技能已成為醫院核心競爭優勢的主要來源。如今政府推動電子病歷交換之時，醫師龐大的工作負荷量與高度專業自主的特質，恐成為政策推動成功與否的一大隱憂。且電子病歷交換涉及知識分享的行為，醫師對於知識分享的態度與行為與其跨院電子病歷交換的意願應有密不可分的關係。本研究從知識分享行為出發，以社會交換理論為研究之理論基礎，探討醫師電子病歷交換意願之影響因素。
本研究針對一家醫學中心與一家區域醫院之就職醫師，發放260份問卷（醫學中心195份，區域醫院65份）進行調查，有效回收220份（醫學中心163份，區域醫院57份），有效回收率為84.62%。問卷回收資料透過結構方程模式之偏最小平方法（Partial least squares, PLS）進行研究模式建立與假說驗證。
整體而言，承諾和依賴與互惠對知識分享行為具有顯著正向影響；溝通對知識分享績效具有顯著正向影響；社會交換理論主要構念中，唯獨依賴與互惠對電子病歷交換具有顯著正向影響；醫師知識分享行為（績效與意圖）對電子病歷交換意願具有顯著正向影響；知識分享行為對於承諾和依賴與互惠與跨院電子病歷交換意願的關係具中介效果。醫學中心而言，承諾和依賴與互惠對知識分享行為具有顯著正向影響；溝通對知識分享績效具有顯著正向影響；社會交換理論主要構念中，唯獨依賴與互惠對電子病歷交換具有顯著正向影響；醫師知識分享行為（意圖）對電子病歷交換意願具有顯著正向影響。區域醫院而言，承諾和依賴與互惠對知識分享行為（績效）具有顯著正向影響，社會交換理論主要構念中，唯獨依賴與互惠對電子病歷交換具有顯著正向影響；醫師知識分享行為（績效）對電子病歷交換意願具有顯著正向影響。
研究結果發現，醫師樂意與他院醫師交換知識，並互相幫助解決醫療問題，以提升個人工作績效。其次，醫師認為跨院電子病歷交換是公平的交換行為，且透過電子病歷交換可以降低醫療決策的時間，並提升彼此的醫療品質。再者，知識分享在模式中佔有一席之地。醫師可透過與他院醫師知識分享的過程中，降低彼此認知上的差異，以提升跨院電子病歷交換的意願。最後，醫學中心醫師較樂意與他院醫師分享知識，並幫助解決他院醫師工作上的問題；區域醫院醫師則較重視與他院醫師分享知識，以提升個人的工作績效及增加組織獲利能力。
In the knowledge-intensive health care industry, knowledge and expertise of the physician has become a core competitive advantage of hospitals. Today, the government has been promoting the cross-hosiptal exchange of electronic medical records (EMR). Nevertheless, the large workload and a high degree of professional autonomy of physicianslead to the barrier of the success on EMR exchange. EMR exchange involves knowledge sharing behavior, thus there should be a close link between the willingness to EMR exchange and physician knowledge sharing behavior. This study uses social exchange theory (SET) as the theoretical basis and explores the influencing factors of physician knowledge sharing behavior and their willingness of cross-hospital EMR exchange.
260 questionnaires (195 medical centers, 65 regional horspitals) were
administerd, and 220 (163 medical centers, 57 regional hospitals) returned, yielding the reponse rate of 84.62%. The data was analyzed through a component-based structural equation modeling approach, partial least squares method to test the hypothesis.
Overall, the commitment and dependence and mutual has a significant and positive effect on knowledge sharing behavior; communication has a significant and positive impact on knowledge sharing performance. Physician knowledge sharing behavior (performance and intentions) has a significant and positive effect on of the willings of EMR exchange. Besides, knowledge sharing behavior has a mediation effect on commitment and communication and EMR exchange, as well as on dependence and reciprocity and EMR exchange.
The study found that physicians are willing to share knowledge with those from other hospitals; they help each other to solve medical problems and to enhance their job performance. Second, physicians believe that the cross-hospital EMR exchange is a fair exchange behavior, and can reduce the time of medical decision-making and enhance each other’s quality of care. Furthermore, dependence and reciprocity and knowledge sharingplays a key role on physician willings of EMR exchange. Physicians treduce their cognitive differences through knowledge sharing and enhance the willingness of cross-hospital electronic medical records exchange. Finally, comparing with medical center physicians, regional hospital physicianspay more attentions to knowledge sharing performane, including enhancing individual work performance and increasing organizational profitability. |
