面對高齡化社會來臨，如何維持長者尊嚴和自主的生活是整個社會和政府的責任；由於老化趨勢，長者醫療需求遠較一般人高，因此，除了照顧食衣住行育樂外，如何在渠等生理機能日趨老化情形下，獲得妥善的醫療照護，實應一併予以思考。 　　政府為安置體能傷殘及單身無依退除役官兵（簡稱榮民），陸續成立18所安養機構（簡稱榮家），現渠等年齡已逾82歲，人數正逐年遞減；在面對人口結構改變與社會快速老化壓力下，行政院國軍退除官兵輔導委員會（簡稱輔導會）亟應思考，如何達到在地老化，將榮家原僅單純負責生活照顧之安養、養護，進一步與醫療體系結合，擴大服務類型為失智及長期照護，實為本研究關注焦點。 　　本研究經由深度訪談及綜合分析發現，榮家如欲永續發展，必須能捨才能得，換言之，安置率偏低的榮家應予整併，並釋出部分資源協助地方政府照顧弱勢民眾；且擴大服務類型，使住民雖因生理機能老化，但仍能在同一園區獲得全程完整的妥善照護；同時提出榮家與榮民醫院（簡稱榮院）在健康管理及醫療照護、復健治療等方面如何結合，使住民長者能即時享有安養與醫療照護；另將榮家現行組織架構修正為依對象和功能來區分，以縮短服務流程，朝向安養精緻化，養護專業化之境界發展。榮家經由前述再造，使住民能獲得全人、全程、全家、全隊的妥善照護，得以節省成本、提升品質、使整體服務獲得肯定外，同時創造榮民、榮家、榮院三贏的效果。 / Facing the arrival of the ageing society, how to maintain the dignity of elderly people and their autonomous livelihood is the responsibility of the entire society and the government. Due to the trend of aging, the medical treatment requirement of elderly people is far much higher than general people. Therefore apart from taking care of their requirements on food, clothing, housing, transportation, education and entertainment, how to enable them to obtain proper medical treatment and care under the condition of their aging physiological function day by day should be considered jointly. 　　In order to help the settling down of the disabled and single and helpless retired officers and soldiers (abbreviated as veterans), the government established eighteen home-care institutions consecutively (abbreviated as Veterans Home). Now their ages are more then eighty two and the number of people declines year after year. While facing with the change in the population structure and the pressure of rapid aging in the society, the Veterans Affairs Commission, Executive Yuan (abbreviated as the Veterans Affairs Commission) should anxiously consider how to achieve localized ageing and change from the condition that they simply bear the responsibility of settling down and maintaining the home care of the veterans home to the state of combining with the medical treatment system and expand the type of service to people with Alzheimer’s disease and long term care. This is the focus of concern of this research. 　　Through in-depth interview and comprehensive analysis this research discovers that if the Veterans Home intends to achieve a sustainable development some sacrifice has to be made in order to obtain gains. In other words, Veterans Home that the settling down rate is low should be combined together and part of the resource should be released to assist the local government to take care of the minority group. In addition, the type of service should be expanded so that although the residents are facing with aging of their physiological function, yet they still can obtain full course and complete proper care in the same area. At the same time, this research also presents on how to combine the Veterans Home with the Veterans General Hospital (abbreviated as the Veterans Hospital) to provide heath management, medical treatment and rehabilitation treatment. This is to enable elder residents to enjoy instant care and medical treatment. Moreover, the present structure of the Veterans Home shall be revised and shall be distinguished according to the target and function. This is to shorten the service flow and to move towards the development of the state of exquisite caring and professional caring. With the above restructure on the Veterans Home, the residents can obtain proper care fully with full course for the entire family with a complete team. Cost can be saved and quality can be enhanced. Apart from wining affirmation on the overall service, the treble win effect of the veterans, the Veterans Home and the Veteran General Hospital can be achieved.

本研究旨在探討榮民醫療體系人力資源管理措施與醫師專業承諾發展現況，兩者的認知差異情形與變項間的相關及預測力。為達研究目的，本研究以問卷調查方式進行，研究工具為自編之「榮民醫療體系人力資源管理措施與醫師專業承諾問卷」，研究對象以全台15所榮民醫療機構醫師為母群體，採分層隨機抽樣法進行。共計發出問卷920份、回收629份，回收率68.4％；經整理編碼，扣除無效問卷後，有效問卷為597份，有效問卷率64.9％。自變項為人力資源管理措施，包含招募甄選、訓練發展、薪資福利、績效評估及員工關係五個構面；依變項為專業承諾，包含專業認同、專業投入及留業意願。資料分析方法採用因素分析及信度分析、描述性統計分析、獨立樣本t檢定、單因子變異數分析、皮爾遜積差相關分析及階層多元迴歸分析。 根據資料分析結果，本研究結論如下： 一、人力資源管理措施各構面認知程度，依序為：訓練發展（3.70）、招募甄選（3.51）、 績效評估（3.40）、員工關係（3.19）、薪資福利（3.15）；專業承諾各構面認知程度，依序為：專業投入（3.89）、專業認同（3.79）、留業意願（3.56）。 二、背景變項中的年齡、服務年資、薪資所得、醫院層級對人力資源管理措施的認知上具有顯著差異。 三、背景變項中的年齡、服務年資、薪資所得、醫院層級對專業承諾的認知上具有顯著差異。 四、人力資源管理措施之招募甄選、訓練發展、薪資福利、績效評估及員工關係五個構面與專業承諾之專業認同、專業投入及留業意願三個構面有顯著正相關。 五、人力資源管理措施之訓練發展、薪資福利及績效評估三構面對專業承諾有顯著的正向影響，其β係數分別為0.364、0.312及0.200。 本研究最後提出管理意涵，提供榮民醫療體系或其他醫療機構行政管理者之參考與借鏡。 / This study aims to examine Veterans Healthcare System current situation of implementing human resource management practices and physician’s professional commitment. In addition, their cognitive difference, correlation and predictability among variables. The researcher proposed study structure and developed a questionnaire entitled as ” The Questionnaire for Human Resource Management Practices and Physician’s Professional Commitment of Veterans Healthcare System ” as the instrument to achieve the purpose of the study. According to the quantity of 15 veterans hospital physicians in Taiwan as a population and the method of Stratified Random Sampling is adopted. A total of 920 copies of questionnaires were given and 629 were returned with a response rates of 68.4％.Through coding and eliminating the unusable questionnaires,there were 597 valid questionnaires with a valid response rates of 64.9％.The independent variables of this study are human resource management practices,include five dimensions：Recruiting and Staffing , Training and Development , Compensation and Benefits, Performance Appraisal and Employee Relationship.The dependent variables are professional commitment , such as Professional Identification, Professional Involvement and Intention to Retain. Data analysis methods adopt Factor and Reliability Analysis, Descriptive Statistical Analysis, Independent Samples t-test, One-Way ANOVA, Pearson Product-Moment Correlation and Hierarchical Multiple Regression Analysis. Based upon the results of data analysis, the conclusions are as follows： 1. The cognition degree in each dimension of human resource management practices in sequential orders are：Training and Development（3.70）, Recruiting and Staffing（3.51）, Performance Appraisal（3.40）, Employee Relationship（3.19）, Compensation and Benefits（3.15）. The cognition degree in professional commitment in sequential orders are：Professional Involvement（3.89）, Professional Identification（3.79）, Intention to Retain（3.56）. 2. Background variables, include age, year of service, salary income and hospital level have an obvious difference of cognition degree toward human resource management practices. 3. Background variables, include age, year of service, salary income and hospital level have an obvious different from the professional commitment. 4. The five dimensions of human resource management practices：Recruiting and Staffing , Training and Development , Compensation and Benefits , Performance Appraisal and Employee Relationship have positive correlation with the three dimensions of professional commitment：Professional Identification , Professional Involvement and Intention to Retain. 5. The three dimensions of human resource management practices：Training and Development , Compensation and Benefits , Performance Appraisal have significant and positive influences on professional commitment , its β coefficient are 0.364, 0.312 and 0.200. Finally , the implication of the studies can offer the administrator of either Veterans Healthcare System or general medical institutions to consult and use as a reference.

榮家安養養護的對象－就養榮民，為年老生活無依著的退伍軍人，他們的青壯時期大都是在戰爭、顚沛的生活中度過，因此大部分的老榮民個性均較為孤僻，不易與人相處，養護的機制需求與一般的養護照顧有所不同。 為能深入瞭解榮民安養、養護機制運作的情形，本研究以平衡計分卡觀點，運用四個構面－財務構面、顧客構面、內部流程構面、學習與成長構面分別透過實地、長期的觀察與對榮家負責人、主管幹部及服務人員作深度訪談的方式，探討榮家養護機制的運作，並藉以瞭解及分析榮家在養護機制上應如何改進，才能符合年老榮民的養護需求，而在面臨社會環境變遷，榮家要如何使養護的資源能充分的使用，以及要如何擴大榮家的服務對象，並提升養護服務品質。 本研究藉由平衡計分卡四個構面的理論架構，探討我國榮民安養、養護機制運作情形，以作為提升養護服務品質及設施（備）、制度改進之參考，期能達成提供榮民有完善的安養、養護機制與頤養天年環境的使命。本研究發現： （一）財務構面：受訪者一致認為榮家應減少非必要之行政支出、加強財務稽查及內部控管機制，將有限預算完全運用在就養榮民的照護工作上。 （二）顧客構面：改善榮家的生活設施及環境、提升服務人員的服務品質、增加文康休閒活動、加強醫療照護，以提高年老榮民至榮家就養的意願。 （三）內部流程構面：建立一套標準的服務作業流程，加強服務人員及內部管理，對提升服務品質至為重要。 （四）學習與成長構面：為提升醫療照護品質，受訪者均認為應加強服務人員的基本醫療照護能力，及專業醫療人員的在職專業訓練教育，並增加醫護人員，以落實養護照顧。 關鍵字：榮民、榮家、平衡計分卡、財務構面、顧客構面、內部流程構面、學習與成長構面 / The subjects for veterans-home to take care of are veterans who are aged ex-servicemen and live helplessly. They spent their days in war and turbulent environments, therefore, most of them have eccentric and unsociable characters, hard to live with others. The requirements for veterans-home are different to other organizations. In order to get a better understanding for the mechanism of veterans-home, this study makes use of the four perspectives from balanced scorecard viewpoint which are financial, customer, internal processes and learning and growth. Through on-the-spot, long-term observation and interviews with the veterans-home personnel to discuss its operation mechanism and provide some suggestions for veterans-home to meet the requirements of aged ex-servicemen. And how does veterans-home make the best use of its resources, broaden its service subjects and promote its service quality while facing the social environment change. This study takes the four perspectives of balanced scorecard as its theory frame to research the settlement of veterans and the operation of settlement mechanism in our country, to offer some suggestions for the references of improving service quality and create a better living environment for the veterans. From this study we find that: 1. Financial perspective: interviewers believe that veterans-home should cut down its unnecessary administration expenses and enhance its financial audit mechanism, in order that the limited budget can be spent on the veterans. 2. Customer perspective: improve living facility and environment of veterans-home, promote the service quality of personnel, increase leisure activities and enhance medical treatment to raise veterans’ desires to live in the veterans-home. 3. Internal processes perspective: establish a standard operation procedure for service, enhance personnel and internal management. 4. Learning and growth perspective: in order to upgrade the medical treatment quality, all the interviewers believe that the basic medical treatment ability for service personnel should be enhanced, as well as the professional training for medical treatment personnel. Key Words : veterans, veterans-home, balanced scorecard, financial perspective, customer perspective, internal processes perspective, learning and growth perspective