知識管理是近來被政府與企業界認為可以產生競爭優勢的重要議題。醫療業為知識密集 (knowledge-intensive) 的產業，因此有效地管理醫療專業知識的創造、整合、儲存、分享與應用，不但將成為醫療機構新的核心競爭力，更能進一步提昇醫療品質與增進人民健康之福祉。然而，醫療本身不論是疾病的產生或是治療的效果，都具有高度的不確定性。此外，醫療業長久以來存在著鮮明的派系問題，愈分愈細的專科與次專科醫師制度，以及生物科技的快速發展，凡此種種皆造成醫療知識的差距愈來巨大，阻礙了醫療知識的整合、分享、創造與應用；此一困境更進一步影響醫療決策品質與醫療品質。因此當務之急，便是建構一套』搜尋與整合不同療法之療效等知識的統治機制』(Phelps,1992; Demsetz,1991)。知識統治機制實為推動知識管理與促進醫療品質的首要基礎建設，然而醫療業在此相關領域尚未建置及整合齊備。有鑒於檢討、整合與建置醫療知識統治機制與其對於知識管理之貢獻的相關研究甚少，因此本研究以質性探索的角度出發，並佐以量性驗證，深入探討醫療知識統治機制的使用現況與其對於知識管理價值鏈的貢獻，並進一步建構醫療知識統治機制、知識管理價值鏈、醫療決策與醫療品質等構面的互動關係模式。研究過程擬分為三個階段。第一階段，利用文獻探討及深度訪談，建構本研究初步命題與模式。第二階段，利用問卷調查式的個案研究方法驗證並修正第一階段研究所建構的命題並建立互動性模式。第三階段，以德菲法試探第二階段研究結果一般化的可能性。本研究期望藉此質量混合，兼顧深度與效度的研究結果，提供政府當局與醫界規劃知識管理以及改善醫療品質之參考工具。 Healthcare industry is a knowledge-intensive industry. Hence, encouraging knowledge sharing among physicians through adequate mechanisms facilitates medical knowledge management, so as to reduce the uncertainty of medical service and enhance medical quality. Since the relevant studies concerning how healthcare industry introduces knowledge management are rare, this study aims to explore the current use of medical knowledge flow mechanisms and their perceived efficiency. Semi-structured questionnaires are used for in-depth interviews with forty physicians selected by purposively stratified sampling. Content analysis and descriptive statistical methods are performed for qualitative and quantitative data analysis respectively. Researchers' triangulation is used to increase the reliability and validity of the study. The result shows that medical knowledge flow mechanisms can be categorized by various knowledge flow units as within the division, among the divisions in a hospital, and among various hospitals of the same specialties. They can also be categorized by various knowledge flow interfaces as face-to-face communication, documental platforms, and information technology platforms. As for their contributions to knowledge management, it is found that face-to-face communication and documental platforms are perceived as more efficient; information technology platforms are otherwise less efficient. The result implicates that healthcare managers' most important task before practicing knowledge management is to conquer the use of information technology among physicians.
