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Due to the digitalization era and challenges faced by the healthcare sector, Medical Information Systems are now being extensively used at hospitals. The implementation of the systems is a complex task which entails a need for careful considerations from a managerial view, since the main purpose with implementing the systems is for managerial control. One of the things management should consider is the professional aspect. The nursing profession is a highly specific one, and this could implicate special considerations. The aim of this master’s thesis is to take on a sociotechnical approach towards the implementation of Medical Information Systems and investigate how the nursing profession is affecting the implementation process, and what it may implicate for hospital management. To answer the research question a qualitative approach has been chosen. The empirical data has been gathered through semi-structured interviews with nurses from the case organization. The result implies that the nursing profession have a substantial impact on the implementation process. Instead of embracing the instructions and support offered by management, the nurses develop their own way of working within the system.

在資訊化與全球化的浪潮之下，政府間的政策趨同（policy convergence）現象，在學術界或是實務界都已有頗多討論。理論上，此議題是比較公共政策的延伸，與政策學習、政策擴散等概念有密不可分的關係；實務上，更是政策過程重要的假定基礎，唯目前學界對於趨同現象的發展仍有許多爭議。本論文主要目的是以政府業務電子化發展為個案，回應資訊化與全球化將提升國家間政策趨同可能性的觀點；並進一步透過個案分析，建構影響政府電子化發展的解釋模型。研究提問首先是政府業務電子化的全球發展，是否產生同型化主義、科技決定論所預測的政策趨同現象？其次是什麼因素影響電子化政府與電子民主參與的發展？為了回答以上研究提問，本論文分析聯合國2003-2005年，以及布朗大學2003-2008年的電子化政府成效調查資料。 研究結果顯示，即使多數文獻認為電子化已成為全球的發展趨勢，並且建構出許多發展階段模型，但資料顯示，全球電子化政府與電子民主參與發展，呈現出「國家間彼此差異擴大，只有部分國家持續往政策理想點移動」的現象。以政策趨同的概念來說，電子化發展成效沒有σ或δ型態的趨同；此外，在發展路徑上，電子化的發展類型沒有一定的規則可循，有些國家先著重線上交易互動，有些先著重電子民主參與，發展路徑多元。此外，透過2003-2005年度的定群資料分析，與2005年資料的分量迴歸分析，包含網路應用程度、全球化程度、人力資本指數、自由程度、相鄰國家發展程度、國民生產毛額..等，都與電子化成效有正向的顯著關係。網路應用程度越高電子化政府發展越好，在專制獨裁型國家的影響效果高於總統制國家；全球化程度越高電子化發展越好，尤其在剛開始發展電子化的國家中。電子化民主參與方面，自由程度是電子化民主參與能否從低階發展到進階的重要因素；網路應用程度與人力資本指數，對高度電子民主參與發展的國家而言是重要的影響因素；相鄰國家的成績越好，發展電子化的動機越強，且影響力量隨著電子化發展成效的上升而加強；最後，經濟條件所產生的影響集中在那些剛開始發展電子化的國家中。在方案的選擇上，影響國家是否優先發展電子民主參與的因素來自於內外在的需求，全球化的程度越高，「電子化政府」就越不可能被忽略，議會制是最不可能優先發展電子民主參與的政體。 本論文基於政策趨同並未發生在電子化個案中的研究發現，主張即使在全球化的架構下，政策趨同的思維有重新界定與分析的必要。在實務上，本論文建議各國政府放棄追求一體適用的全球性架構，停止國際名次的追求，建構以地方為中心、使用者為導向的電子化措施。整體而言，本論文的貢獻為全球化與資訊化環境底下的政策發展理論，提供了新的實證資料與解釋，也對長期以來科技決定論與社會科技主義兩者平衡提供了一個穩固的基礎。 / Both e-government and e-participation have been recognized as worldwide trends. Many studies offer e-government development models that are based on intellectual speculation rather than data from empirical observation. This research argues that both e-government and e-participation are not only incorrectly dominated by technology determinism, but also misuse the global policy convergence assumption. Although the cross-national policy convergence is an established issue in comparative research, its academic popularity has not resulted in a general consensus. Whether societies become more and more alike, implement similar policies, or pursue the same policy goal is still an unanswered question. By analyzing the United Nation's 2003-2005 e-government index and Brown University's 2003-2008 e-government survey data, this paper aims to achieve two goals: the first is to analyze the development path of global e-government and e-participation, and to answer the question whether global e-government and e-participation performance have converged on the ideal policy point; the second is to construct e-government and e-participation performance models for different types of regimes. The findings show that there is no sigma convergence which means the difference of performances among countries is decreasing over time, and there is also no delta convergence which means all counties are pursing the same ideal point. Regarding the development path, only a few counties converge on (abide by) the theoretical speculation. The findings of the second research question show that the competition pressure from the neighboring countries, the degree of globalization, human capital index, freedom index, the percentage of internet users, and GDP all have positive associations with e-government and e-participation performance. It is also interesting to note that there are some important differences noticed in the different stages of the conditional distribution of e-government and e-participation. While the effect of competition pressure is not significant for all countries, the results show that it is significant for countries classified as highly developed. The freedom degree has a positive significant effect on countries that have developed higher e-participation and shows no association with countries that are less developed in the area of e-participation. The competition pressure has a higher effect on a presidential system than a parliamentary system and the degree of globalization produce higher pressure on a parliamentary system than on a presidential system. A key factor for the early development of e-participation is citizen needs, but for the further maintenance of e-participation, this factor must be coupled with the degree of societal freedom. In conclusion, this research argues that both e-government and e-participation development do not have a generally agreed upon global framework. Taiwan should focus on local citizens needs; give up the pursuit of the title of world leader; and rebuild the e- policy vision.

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