Abstract This research take ¡§the service quality¡¨, ¡§the customer degree of satisfaction¡¨ and ¡§the customer loyalty¡¨ is variable as the research, reads the domestic and foreign various experts to propose the research theory and the argument, and as studies the parent substance take ¡§some area Teaching hospital¡¨, in view of ¡§the populace who once arrived at some area Teaching hospital in hospital¡¨ are the sampling objects, carries on the paper questionnaire real diagnosis work, conducts the above three research variable mutual relatedness research. This research main discovery is: 1. ¡§The medical procedure¡¨ the partial degree of satisfaction and the patient loyalty ¡§will need the medical service regarding the medical service quality to come this courtyard again once more?¡¨Present that the intense forward relational existence. 2. ¡§The service result¡¨ the partial degree of satisfaction and the patient loyalty ¡§will need the medical service regarding the medical service quality to come this courtyard again once more?¡¨ Present that the intense forward relational existence. 3. ¡§The medical procedure¡¨ partial satisfaction and the patient loyalty ¡§the relatives and friends needs the medical service regarding the medical service quality to be willing to introduce this courtyard?¡¨ Present that the intense forward relational existence. 4. ¡§The service result¡¨ partial satisfaction ¡§the relatives and friends needs the medical service regarding the medical service quality in with the patient loyalty to be willing to introduce this courtyard?¡¨ Present that the intense forward relational existence. 5. (1) Demography and in the medical service quality's of variance analysis hospital ward environment facility degree of satisfaction, filling in artificial myself must myself have outside the remarkable difference regarding the hospital ward environment facility degree of satisfaction. (2) Demography and in the medical service quality's of variance analysis staff service attitude degree of satisfaction, filling in artificial myself must myself have the remarkable difference (3) Demography and in medical service quality of variance analysis knowing medical procedure degree of satisfaction regarding the staff service attitude degree of satisfaction, filling in artificial myself must myself have the remarkable difference and the female regarding the medical procedure degree of satisfaction compare the male to have the remarkable difference regarding the medical procedure degree of satisfaction. (4) Demography and in medical service quality's service result degree of satisfaction variance analysis knowing, filling in artificial myself must myself have the remarkable difference regarding the service result degree of satisfaction. 6. (1) Goes see a doctor the background and in medical service quality of variance analysis knowing hospital ward environment facility degree of satisfaction; Regarding chooses factor of this courtyard¡§to recommend, ¡§the good communications¡¨ for the relatives and friends¡¨, ¡§the medical skill to be wise¡¨ and ¡§the service attitude is good¡¨ the option to the hospital ward environment facility degree of satisfaction to have the remarkable difference. (2) Goes see a doctor the background and in medical service quality of variance analysis knowing staff service attitude degree of satisfaction, chooses in this courtyard the factor ¡§to be good for the service attitude¡¨ to goes see a doctor the background and the staff service attitude degree of satisfaction has the remarkable difference. (3) Goes see a doctor the background and in the medical service quality of variance analysis medical procedure degree of satisfaction, ¡§the relatives and friends recommend¡¨, ¡§the good communications¡¨, ¡§the medical skill to be wise¡¨, ¡§the service attitude to be good¡¨The option has the remarkable difference. (4) Goes see a doctor the background and in the medical service quality of variance analysis administrative efficiency degree of satisfaction, the option is ¡§the place is moderate¡¨, ¡§the medical equipment to be good¡¨ has the remarkable difference. (5) Goes see a doctor the background and in the medical service quality of variance analysis service result degree of satisfaction, the gynecology and obstetrics department has the remarkable difference compared to the surgical department: In hospital way outpatient service has the remarkable difference compared to the emergency medical treatment. 6. Customer sickness in medical service satisfaction which provides to the hospital by medical procedure part satisfaction and the service result actually important attribute. Has the intense predictive ability with the patient loyalty. Key words:Service Quality, Customer degree of Satisfaction, Patient Loyalty, local Hospital

There is a trend that the phenomenon of inequality is behaved in the market of medical treatment after the exercise of public health insurance. The large-scale hospitals incrementally enlarge to squeeze the survival condition of small and medium hospitals under the situation that supreme will survive to enhance competitive advantage. The competition is fierce between local hospitals to be based on the inequality of survival condition and unreasonable payment system of public health insurance. The research of Tong-Liang Chiang and Ming-San Huang (2000) indicates following phenomenon: the 77% of manager of local hospitals think that the competition is obviously increased between local hospitals after the exercise of public health insurance. The job insecurity of employees is generated by the expecting psychological condition that is derived from change in the organization under the impact of current environment and pressure of survival. What is the response of work influenced by job insecurity? What is the management lesson of hospital brought in the competition of hospitals? I hope to find the real response of employees under situation that feeling of job insecurity is derived by the expecting psychological condition of change in the organization. What is the relationship by the addition of individual personality? There are main findings in the research through the analysis of evidence: 1. Job insecurity is evident positive relevant to variation on work scenario, variation on structure of human resource, variation on management pattern of organization and variation on opportunity of employment that is belongs to the expecting factor of change in the organization. The higher score of variation on work scenario, variation on structure of human resource, variation on management pattern of organization and variation on opportunity of employment, the much easier generation of job insecurity. 2. For the job insecurity, the deviation of explanation on job insecurity is evidently related with the model of expecting factor of change in the organization. And the variation on work scenario and variation on opportunity of employment are evidently influenced by job security. 3. Job insecurity is partial evidently related with the immediate effect that is derived between the expecting change in organization and organizational commitment, leave attitude, work satisfaction, service attitude. 4. The employees that have personality of self-control are evidently interfered by the job insecurity that is derived from variation on work scenario, variation on opportunity of employment, variation on management pattern of organization and variation on work character. The employees that have personality of extraversion are evidently interfered by the job insecurity that is derived from variation on structure of human resource and variation on work character.

Over the past 25 years, health care organization scholars have observed the dramatic emergence of hospital-based clusters in local markets throughout the U.S. These important organizational forms require same-system ownership of multiple general, acute care hospitals operating within a single local market, and as such they include multi-hospital systems that are entirely contained in a single urban market as well as clustered extensions or subsystems of larger regional and national systems. However, despite their noted growth as powerful forces in local markets, relatively few studies have examined these clusters, and as a result there remains a significant gap in our knowledge regarding their continued growth or the diverse components and configurations they may exhibit. This study endeavors to both describe and explain the diversity observed across hospital-based clusters. To fulfill this objective, a national inventory of clusters is updated to reflect cluster membership as of 2012, and a catalog of cluster components – including their hospital-based and non-hospital-based sites – is created, acknowledging that clusters today consist of more than just general, acute care hospitals. Cluster analysis methods are then employed to develop a taxonomy of cluster forms, using a sample of 114 clusters from local markets in Florida, Maryland, Nevada, Texas, Virginia, and Washington. Applying a conceptual framework informed by concepts from contingency theory and strategic management theory, cluster analysis methods yield a five-group solution, which is then externally validated using a multi-theoretical perspective synthesizing arguments from population ecology, institutional theory, industrial organization economics, transaction cost economics, and resource dependence theory. Results from descriptive and multinomial logistic regression analyses identify organizational and environmental factors that are significantly associated with various cluster forms. The study’s results suggest that today’s hospital-based clusters continue to grow and vary according to the dimensions of differentiation-configuration and integration-coordination. These findings provide a foundation for future examinations of hospital-based clusters, including their provision of services within and outside of hospital walls. These results also accentuate the importance of accounting for geographic considerations when examining health care organization forms, and they display the utility and value of employing a multi-theoretical perspective to examine and explain such complex forms.