本文聚焦於探討「衛生福利部所屬醫療機構績效評核原則」之設計內涵，並以部立醫院醫師為分析標的，進一步應用必要任務屬性理論來檢視醫師之任務屬性 (例行性、非例行性)、績效量度設計之配適程度 (激勵性、不適切性) 對工作績效之影響。透過問卷調查方式取得218份研究樣本，實證結果發現：(1) 醫師認知績效量度在設計面之配適性會影響其工作績效。然而現行臨床工作績效量度並無法對醫師形成激勵效果；(2) 當醫師從事「非例行性」程度越高的臨床服務工作時，會因認知現行績效量度不具適切性，進而間接對其臨床服務績效產生負向影響。(3) 當醫師從事「例行性」程度越高的公共服務工作時，會認知現行績效量度具激勵性，進而間接對其公共服務績效產生正向影響。

This paper introduces “theory of requisite task attributes” and examines the effect of physicians’ task attributes (routine and non-routine) and fitness of performance measures (degree of motivation and noise) on with the doctors from the hospitals under Taiwan’s Ministry of Health and Welfare. There are 218 research samplescollected through a questionnaire survey. Empirical results show that: (1) Physicians’ cognition of fitness of performance measures has a positive effect on job performance. The noise of performance measures has significant negative effect on job performance, and the motivation of performance measures has significant positive effect on job performance. (2) The relationship between non-routine task attributes and clinical job performance can be fully mediated by the noise of clinical job performance measures where non-routine task attributes decrease the noise of performance measure, and the noise of performance measure is negatively associated with clinical job performance. (3) However, the relationship between routine task attributes and public service job performance can be accounted for by a partial mediation where routine task attributes increase the motivation of public service performance measures, and the motivation of performance measures is positively associated with public service job performance.

本研究聚焦於探討「衛生福利部所屬醫療機構績效評核原則」之設計內涵，並以部立醫院醫師為分析標的，進一步應用必要任務屬性理論來探討醫師的任務屬性 (例行性、非例行性)、績效量度配適性 (激勵性、不適切性) 對工作績效 (臨床服務與公共服務績效) 之影響。本研究依據實證發現對衛生福利部提出相關實務管理意涵：（1）績效評估系統之設計應與部立醫院的成立宗旨或經營策略整合，目的在轉化醫院無形的策略為具體行動方案。由於現行「績效評核原則」是以「工作類別」為前提來設計績效量度，讓所屬的從業醫師無法澄清與了解醫院策略與個人工作內涵之關聯性，此為績效評估系統在規劃面首要改善的工作。（2）建議績效評估系統應針對不同科別來規劃其客製化或專屬的績效構面及其對應之績效量度。主要目的在於打破現行不分科而採行「臨床服務」與「公共服務」績效量度二分法之設計。（3）績效構面或績效量度間應具備某種程度之因果關聯性。此策略地圖之觀點在於引導從業人員達成組織目標，同時強化個人目標與組織目標之一致性。（4）建議績效量度之項目宜適當，避免過多的績效量度反而失去激勵從業人員之效。依據Kaplan amd Norton (1996) 之主張，績效量度盡量不要超出16項，俾降低過多的績效量度反而妨礙正常工作之執行。（5）建議加入績效權重的設計觀點，主要目的在於避免從業人員陷入追求易達成的績效量度。畢竟不同績效構面或績效量度之達成確實有其難易程度，若缺乏權重設計考量下的績效評估系統，將導致從業人員致力於較易達成的績效量度，放棄追求其他重要但卻是較難達成的績效要求；此外，權重設計之觀點更賦予較難達成的工作任務有較重的加權佔比，畢竟風險高且變化程度高的臨床工作有較重的績效權重，不僅代表醫師達成時有較高的評估基準，同時亦凸顯出醫師臨床工作之重要性，俾產生最終激勵之效。

方瑞雯、白映俞、吳佳璇、吳靜芬、李紹榕、林秉鴻、亮亮、張志華、陳珮琪、劉育志、蔡宏斌、蔡秀男、錢建文、Maggie Lin、蘇柏熙，2012，醫療崩壞！沒有醫師救命的時代，初版，台北：貓頭鷹。(Fang, J. W., Pai, Y. Y., Wu, C. H., Wu, C. F., Li, S. J., Lin, P. H., Liang, L., Chang, C. H., Chen, P. C., Liu, Y. C., Tsai, H. P., Tsai, H. N., Chien, C. W., Lin, M., and Su, P. H., 2012, The Medical Treatment Collapses Bad! There is no Doctor Helping of Ages, 1st, Taipei, TW: Mao Tou Ying.)
李佳玲、史雅男、邱筠淇，2012，「不確定性、協同合作與管理控制系統之關聯性」，會計評論，55期：77~117。(Wang, W. L., Lee, C. L., Shih, Y. N., and Chiu, Y. C., 2012, “The Relationship between Uncertainty, Collaboration and Management Control System,” International Journal of Accounting Studies, Vol. 55, 77-117.)
邱炳乾，2006，「預算目標達成對風險投資的影響：展望理論與過去績效歸因的探討」，管理與系統，13卷1期：77~97頁。(Chiou, B. C., 2006, “The Impacts of Budgetary Goal Attainment on Risky Investment: Prospect Theory and Previous Performance Attribution,” Journal of Management & Systems, Vol. 13, No. 1, 77-97.)
祝道松、林淑美、倪豐裕，2003，「預算目標困難、對預算參與、預算目標接受、與管理績效間關係影響之探討：以台灣地區製造業為例」，管理學報，20卷5期：1023~1043。(Zhu, D. S., Lin, S. M., and Ni, F. Y., 2003, “A Study of the Effect of Budgetary Goal Difficulty on the Relationships among Budgetary Participation, Budgetary Goal Acceptance, and Managerial Performance: Manufacturing Industry in Taiwan as Example,” Journal of Management, Vol. 20, No. 5, 1023-1043.)
祝道松、彭雅惠、董鈺琪、龔建吉、陳秀珠、陶阿倫，2018，醫療機構成本與管理會計，二版，台北：華杏出版社。(Zhu, D. S., Peng, Y. H., Tung, Y. C., Kung, C. C., Chen, H. C., and Talbot, A. R., 2018, Healthcare Organization Cost and Management Accounting, 2nd, Taipei, TW: Farseeing Publishing Group.)
倪豐裕、莊曜愷、邱炳乾，2006，「知覺任務不確定性、組織承諾、管理會計資訊系統三者對管理績效交互作用之影響」，管理與系統，13卷1期：1~14。(Ni, F. Y., Chuang, Y. K., and Chiou, B. C., 2006, “Perceived Task Uncertainty, Organizational Commitment, Managerial Accounting Systems and Their Three-Way Interaction Effects on Managerial Performance,” Journal of Management & Systems, Vol. 13, No. 1, 1-14.)
倪豐裕、蘇錦俊、鍾紹熙、鄭國枝，2009，「預算參與對管理者效能之影響：自我效能與態度的中介角色」，臺大管理論叢，19卷2期：321~348。(Ni, F. Y., Su, C. C., Chung, S. H., and Cheng, K. C., 2009, “Budgetary Participation’s Effect on Managerial Outcomes: Mediating Roles of Self-efficacy and Attitudes toward Budgetary Decision Makers,” NTU Management Review, Vol. 19, No. 2, 321-348.)
陳燕錫、陳瓊燕，2014，「會計師事務所與管理顧問公司聯盟之經營績效探討」，會計評論，59期：73~105。(Chen, Y. S. and Chen, C. Y., 2014, “Audit Firms’ Alliance with Consulting Firms for Management Advisory Services and Operational Performance,” International Journal of Accounting Studies, Vol. 59, 73-105.)
張石柱、盧文民、吳濬豪，2010，「智慧資本與專案績效關聯性之探討：經濟部科技專案之實證研究」，當代會計，11卷2期：179~214。(Chang, S. J., Lu, W. M., and Wu, C. H., 2010, “The Study of the Relationship between Intellectual Capital and Project Performance: The Empirical Study of Technology Project of Ministry of Economic Affairs,” Journal of Contemporary Accounting, Vol. 11, No. 2, 179-214.)
張志華、方瑞雯、吳靜芬、李紹榕、林秉鴻、亮亮、洪浩雲、柯紹華、施景中、陳欣湄、陳豐偉、葉勝雄、楊佳陵、銅鈸、劉育志、劉宗瑀、蔡宏斌、蔡秀男、錢建文、蘇柏熙，臺灣醫療勞動正義與病人安全促進聯盟 (醫勞盟)，2014，臨床隨行，走出白色巨塔陰影，初版，臺北：三采出版社。 (Chang, C. H., Fang, J. W., Wu, C. F., Li, S. J., Lin, P. H., Liang, L., Hung, H. Y., Ko, S. H., Shih, C. C., Chen, H. M., Chen, F. W., Yeh, S. H., Yang, C. L., Tung, P., Liu, Y. C., Liu, T, Y., Tsai, H. P., Tsai, H. N., Chien, C. W., Su, P. H., and Taiwan Medical Alliance for Labor Justice and Patient Safety (TMAL), 2014, Clinic Shadowing, Walking through Darkness , 1st, Taipei, TW: Sun Color Group.)
楊建昌、廖又生、楊紅玉、廖茂宏、邱淑芬，2011，「台灣醫療機構員工工作態度與組織績效相關性之研究」，健康管理學刊，9卷1期：29~42。(Yang, C. C., Liao, Y. S., Tang, H. Y., Liao, M. H., and Chiu, S. F., 2011, “A Study of the Correlation between Staffs’ Job Attitudes and Organizational Performance of Taiwan Medical Institutions,” Journal of Health Management, Vol. 9, No. 1, 29-42.)
蔡繼志，2010，「簡介美國醫院醫療品質比較之現況」，臺灣醫界，53卷12期：42~44。(Tsai, J. J., 2010, “An Introduction to Compare with Medical Quality in American Hospitals,” Taiwan Medical Journal, Vol. 53, No. 12, 42-44.)
劉育志，2012，醫療崩壞-烏托邦的實現與幻滅，初版，台北：華成出版社。(Liu, Y. C., 2012, Medical Collapsing: The Rise and Disillusionment of Utopia, 1st, Taipei, TW: Far Reaching Publishing Co. Ltd.)
鄭國枝、楊美玲、蘇錦俊、丁念茹，2013，「預算控制與管理會計系統是否能提昇產品創新績效」，中山管理評論，21卷3期：545~577。(Cheng, K. C., Yang, M. L., Su, C. C., and Ting, N. J., 2013, “How Can Budget Control and Management Accounting System Improve Product Innovation Performance,” Sun Yat-sen Management Review, Vol. 21, No. 3, 545-577.)
衛生福利部網站，2016，「衛生福利部所屬醫療機構管理法規彙編：衛生福利部所屬醫療機構績效評核原則」，http://www.hso.mohw.gov.tw/rules/21.doc。(Ministry of Health and Welfare, 2016, “Law and Regilations of Ministry of Health and Welfare: Performance Measurement Principle for for the Hospitals of Ministry of Health and Welfare,” http://www.hso.mohw.gov.tw/rules/21.doc, accessed on March 31, 2016)
Abernethy, M. A., Bouwens, J., and Lent, L., 2013, “The Role of Performance Measures in the Intertemporal Decisions of Business Unit Managers,” Contemporary Accounting Research, Vol. 30, No. 3, 925-961.
Abernethy, M. A. and Stoelwinder, J. U., 1991, “Budget Use, Task Uncertainty, System Goal Orientation and Subunit Performance: A Test of the Fit Hypothesis in Not-for-profit Hospitals,” Accounting, Organizations and Society, Vol. 16, No. 2, 105-120.
Abernethy, M. A. and Stoelwinder, J. U., 1995, “The Role of Professional Control in the Management of Complex Organizations,” Accounting, Organizations and Society, Vol. 20, No. 1, 1-17.
Abernethy, M. A. and Vagnoni, E., 2004, “Power, Organization Design and Managerial Behavior,” Accounting, Organizations and Society, Vol. 29, No. 3/4, 207-225.
Aidemark, L. G. and Funck, E. K., 2009, “Measurement and Health Care Management,” Financial Accountability & Management, Vol. 25, No. 5, 253-327.
Armstrong, J. S. and Overton, T. S., 1977, “Estimating Non-response Bias in Mail Survey,” Journal of Marketing Research, Vol. 14, No. 3, 396-402.
Arnold, M. C. and Artz, M., 2015, “Target Difficulty, Target Flexibility, and Firm Performance: Evidence from Business Units’ Targets,” Accounting, Organizations and Society, Vol. 40, No. 1, 61-77.
Artz, M., Homburg, C., and Rajab, T., 2012, “Performance-Measurement System Design and Functional Strategic Decision influence: The Role of Performance-measure Properties,” Accounting, Organizations & Society, Vol. 37, No. 7, 445-460.
Bai, G., Coronado, F., and Krishnan, R., 2010, “The Role of Performance Measure Noise in Mediating the Relation between Task Complexity and Outsourcing,” Journal of Management Accounting Research, Vol. 22, No. 1, 75-102.
Bagozzi, R. P. and Yi, Y., 1988, “On the Evaluation of Structural Equation Models,” Journal of the Academy of Marketing Science, Vol. 16, No. 1, 74-94.
Bouillon, M. L., Ferrier, G. D., Stuebs, M. T., and West, T. D., 2006, “The Economic Benefit of Goal Congruence and Implications for Management Control Systems,” Journal of Accounting & Public Policy, Vol. 25, No. 3, 265-298.
Budde, J., 2007, “Performance Measure Congruity and the Balanced Scorecard,” Journal of Accounting Research, Vol. 45, No. 3, 515-539.
Burney, L. L. and Widener, S. K., 2007, “Strategic Performance Measurement Systems, Job-relevant Information, and Managerial Behavioral Responses- role Stress and Performance,” Behavioral Research in Accounting, Vol. 19, 43-69.
Burney, L. L., Henle, C. A., and Widener, S. K., 2009, “A Path Model Examining the Relations among Strategic Performance Measurement System Characteristics, Organizational Justice, and Extra- and In-role Performance,” Accounting, Organizations & Society , Vol. 34, No. 3/4, 305-321.
Campbell, D., 2008, “Nonfinancial Performance Measures and Promotion-based Incentives,” Journal of Accounting Research, Vol. 46, No. 2, 297-332.
Cheng, M. M. and Humphreys, K. A., 2012, “The Differential Improvement Effects of the Strategy Map and Scorecard Perspectives on Managers’ Strategic Judgments,” The Accounting Review, Vol. 87, No. 3, 899-924.
Chenhall, R. H., 2005, “Integrative Strategic Performance Measurement Systems, Strategic Alignment of Manufacturing, Learning and Strategic Outcomes: An Exploratory Study,” Accounting, Organizations and Society, Vol. 30, No. 5, 395-422.
Choe, J. M., 1998, “The Effects of User Participation on the Design of Accounting Information Systems,” Information & Management, Vol. 34, No. 3, 185-198.
Choudhury, N., 1986, “Responsibility Accounting and Controllability,” Accounting and Business Research, Vol. 16, No. 3, 189-198.
Cianci, A. M., Kaplan, S. E., and Samues, J. A., 2013, “The Moderating Effects of the Incentive System and Performance Measure on Managers’ and Their Superiors’ Expectations about the Manager’s Effort,” Behavioral Research in Accounting, Vol. 25, No. 1, 115-134.
Cohen, J. F. and Toleman, M., 2006, “The IS – Business Relationship and its Implications for Performance: An Empirical Study of South African and Australian Organizations,” International Journal of Information Management, Vol. 26, No. 6, 457-468.
Dailey, R. C., 1979, “Locus of Control Task Attributes and Job Performance,” Perceptual and Motor Skills, Vol. 49, No. 2, 489-490.
Daft, R. L., 2001, Organization Theory and Design, 7st, Cincinnati: South-Western.
Dekker, H. C., Groot, T., and Schoute, M., 2012, “Determining Performance Targets,” Behavioral Research in Accounting, Vol. 24, No. 2, 21-46.
Dess, G. G. and Beard. D. W., 1984, “Dimensions of Organizantional Task Environments,” Administrative Science Quarterly, Vol. 29, No. 1, 52-73.
Feltham, G. A. and Xie, J., 1994, “Performance Measure Congruity and Diversity in Multi-task Principal/Agent Relations,” The Accounting Review, Vol. 69, No. 3, 429-453.
Gates, S. and Germain, C., 2010, “Integrating Sustainability Measures into Strategic Performance Measurement Systems: An Empirical Study,” Management Accounting Quarterly, Vol. 11, No. 3, 1-7.
Gopalakrishnan, M., Libby, T., Samuels, J. A., and Swenson, D., 2015, “The Effect of Cost Goal Specificity and New Product Development Process on Cost Reduction Performance,” Accounting, Organizations and Society, Vol. 42, No. 1, 1-11.
Govindarajan, V. and Gupta, A. K., 1985, “Linking Control Systems to Business Unit Strategy: Impact on Performance,” Accounting, Organizations and Society, Vol. 10, No. 1, 51-66.
Grafton, J., Lillis, A. M., and Widener, S. K., 2010, “The Role of Performance Measurement and Evaluation in Building Organizational Capabilities and Performance,” Accounting, Organizations and Society, Vol. 35, No. 7, 689-706.
Hackman, J. R. and Lawler, E. E., 1971, “Employee Reaction to Job Characteristics,” Journal of Applied Psychology, Vol. 55, No. 3, 259-286.
Hackman, J. R. and Oldham, G. R., 1975, “Development of the Job Diagnostic Survey,” Journal of Applied Psychology, Vol. 60, No. 2, 159-170.
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., and Tatham, R. L., 2010, Multivariate Data Analysis, 7th, Upper Saddle River: Prentice Hall International.
Hall, M., 2008, “The Effect of Comprehensive Performance Measurement Systems on Role Clarity, Psychological Empowerment and Managerial Performance,” Accounting, Organization and Society, Vol. 33, No. 2/3, 141-163.
Ho, J. L. Y., Wu, A., and Wu, S. Y. C., 2014, “Performance Measures, Consensus on Strategy Implementation, and Performance: Evidence from the Operational-level of Organizations,” Accounting, Organizations and Society, Vol. 39, No. 1, 38-58.
Hopwood, A. G., 1972, “An Empirical Study of the Role of Accounting Data in Performance Evaluation. Empirical Research in Accounting Studies: Selected Studies,” Journal of Accounting Research, Vol. 10, 156-182.
Ines, R., Mattania, T., Hendriek, C. B., Catharina, E. J., and Huibert, T. D., 2002, “Selection Bias Due to Non-response in A Health Survey among Patients with Rheumatoid Arthritis,” European Journal of Public Health, Vol. 12, No. 2, 131-135.
Itami, H., 1975, “Evaluation Measures and Goal Congruence under Uncertainty,” Journal of Accounting Research, Vol. 13, No. 1, 73-96.
Ittner, C. D. and Larcker, D. F., 1998, “Innovations in Performance Measurement: Trends and Research Implications,” Journal of Management Accounting Research, Vol. 10, 205-238.
Ittner, C. D., Larcker, D. F., and Rajan, M. V., 1997, “The Choice of Performance Measures in Annual Bonus Contracts,” The Accounting Review, Vol. 72, No. 2, 231-255.
Janssen, O., Van De Vliert, E., and Veenstra, C., 1999, “How Task and Person Conflict Shape the Role of Positive Interdependence in Management Teams,” Journal of Management, Vol. 25, No. 2, 117-141.
Jap, S. D. and Anderson, E., 2003, “Safeguarding Interorganizational Performance and Continuity under Ex Post Opportunism,” Management Science, Vol. 49, No. 12, 1684-1701.
Jehn, K. A., 1995, “A Multimethod Examination of the Benefits and Detriments of Intragroup Conflict,” Administrative Science Quarterly, Vol. 40, No. 2, 256-283.
Johnson, H. T. and Kaplan, R. S., 1987, Relevance Lost, 1st, Boston: Harvard Business School Press.
Jöreskog, K. G. and Sörbom, D., 1993, LISREL 8: User’s Reference Guide, 3rd, Mooresville: Scientific Software.
Kaplan, R. S. and Norton, D. P., 1996, The Balanced Scorecard: Translating Strategy into Action, 1st, Boston: Harvard Business School Press.
Kaplan, R. S. and Norton, D. P., 2004, Strategy Maps: Converting Intangible Assets into Tangible Outcomes, 1st, Boston: Harvard Business School Press.
Kaplan, R. S. and Norton, D. P., 2006, Alignment：Using the Balanced Scorecard to Create Corporate Synergies, 1st, Boston: Harvard Business School Press.
Kaplan, R. S. and Norton, D. P., 2009, Execution Premium: Linking Strategy to Operations for Competitive Advantage, 1st, Boston: Harvard Business School Press.
Kelly, K., 2010, “Accuracy of Relative Weights on Multiple Leading Performance Measures: Effects on Managerial Performance and Knowledge,” Contemporary Accounting Research, Vol. 27, No. 2, 577-608.
Kelly, K. O., Webb, R. A., and Vance, T., 2015, “The Interactive Effects of Ex Post Goal Adjustment and Goal Difficulty on Performance,” Journal of Management Accounting Research, Vol. 27, No. 1, 1-25.
Lillis, A. M., 2002, “Managing Multiple Dimensions of Manufacturing Performance- An Exploratory Study,” Accounting, Organization and Society, Vol. 27, No. 6, 497-529.
Marginsona, D., McAulayb, L., Roushc, M., and van Zijl. T., 2014, “Examining A Positive Psychological Role for Performance Measures,” Management Accounting Research, Vol. 25, No. 1, 63-75.
McDonald, R. P. and Ho, M. R., 2002, “Principle and Practice in Reporting Structural Equation Analysis,” Psychological Methods, Vol. 7, No. 1, 64-82.
Motowidlo, S. J. and Scotter, J. R. V., 1994, “Evidence that Task Performance Should be Distinguished from Contextual Performance,” Journal of Applied Psycholog, Vol. 79, No. 4, 475-480.
Nancy, M. D., 2000, Common Knowledge: How Companies Thrive by Sharing What They Know, 1st, Boston: Harvard Business School Press.
Nunnally, J., 1978, Psychometric Theory, 1st, New York: Mcgraw-Hill.
Orpen, C., 1986, “The Relationship between Perceived Task Attributes and Job Satisfaction and Performance among Plateaued and Nonplateaued Managers,” Human Systems Management, Vol. 6, No. 1, 15-20.
Perego, P. and Hartmann, F., 2009, “Aligning Performance Measurement Systems with Strategy: The Case of Environmental Strategy,” Abacus, Vol. 45, No. 4, 397-428.
Podsakoff, P. M., MacKenzie, S. B., and Podsakoff, N. P., 2003, “Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies,” Journal of Applied Psychology, Vol. 88, No. 5, 879-903.
Preacher, K. J. and Hayes, A. F., 2008, “Asymptotic and Resampling Strategies for Assessing and Comparing Indirect Effects in Multiple Mediatormodels,” Behavioral Research Methods, Vol. 40, No. 3, 879-891.
Presslee, A., Vance, T. W., and Webb, R. A., 2013, “The Effects of Reward Type on Employee Goal Setting, Goal Commitment, and Performance,” The Accounting Review, Vol. 88, No. 5, 1805-1831.
Scott, J. E., 1995, “The Measurement of Information System Effectiveness: Evaluating A Measuring Instrument,” ACM SIGMIS Database, Vol. 26, No. 1, pp. 43-61.
Shields, M. D., Deng, F. J., and Kato, Y., 2000, “The Design and Effects of Control Systems: Tests of Direct- and Indirect-effects Models,” Accounting, Organizations and Society, Vol. 31, No. 2, 185-202.
Turner, N. and Lawrence, R., 1965, Industrial Jobs and the Worker, 1st, Boston: Harvard Graduate School of Business Administration.
Webb, R. A., 2004, “Managers’ Commitment to the Goals Contained in A Strategic Performance Measurement System,” Contemporary Accounting Research, Vol. 21, No. 4, 925-958.
Webb, A., Jeffrey, S. A., and Schulz, A., 2010, “Factors Affecting Goal Difficulty and Performance When Employees Select Their Own Performance Goals: Evidence from the Field,” Journal of Management Accounting Research, Vol. 22, No. 1, 209-232.