自1980年代開始，新管理主義或新公共管理成為各國健康照護改革的主要基調，在此背景下，個案管理這種宣稱能節省醫療支出、兼顧品質與效能的策略被引入健康照護領域。然而，當具備護理專業的個案管理師被要求使用標準化、量化與線性的管理工具從事照護，並從結果測量照護成效時，她們的專業認同和照護實作出現哪些轉變？這種模式是否能提供良好照護、滿足病人需求？有無存在哪些照護風險或非預期的效應？這些都是本研究想要探討的問題。本研究採建制民族誌，從腫瘤個管師的立足點探討個案管理照護模式的社會組織。研究期程預計三年，第一年聚焦在南部某家醫院血液腫瘤科的十位個案管理師身上，探究她們如何思考、如何工作；第二年針對幾個能凸顯病人真實與建制間斷裂和矛盾的案例，進行向下（病人及家屬）、向旁（專業醫療照護團隊）及向上（醫院管理階層）的延伸式探究，逐步繪製出支配關係的地圖；第三年將研究場域轉向其他慢性病科別，以比較不同科別底下，個案管理照護模式的異同。資料蒐集方法包括訪談、參與觀察與工作文本的分析。本研究企圖透過探究個案管理這種主流照護模式的社會組織，分析專業醫護人員的照護信念和實作如何為新管理主義所支配和轉化，以及病人的需求如何被（不）滿足，對當前健康照護改革作出批判性的省思和檢討。 Since the 1980s, the governance of health care reform across countries has been influenced by new managerialism or new public management, and hence the notion of case management was introduced and claimed to be a cost effective strategy, enhancing both the quality and the efficiency of performing health care. The purpose of the present study is to examine 1) how this new form of managerial value has implemented in a health care setting and changed the professional identities and working processes/practices of the case managers with nursing background, particularly when they are expected to perform standardized care and evaluated quantitatively by rigid managerial techniques? 2) can this new form of management provide good quality of care and meet the needs of the patients? or 3) are there any unexpected risks, cost and/or consequences? This three-year research project adopts institutional ethnography (IE) to investigate the standpoint of case managers for cancer patients in a southern hospital and the social organization of care they are embedded. In the first year, I focus on the working processes/practices of these case managers. In the second year, I examine the patients and their experiences of disjuncture that allow me to map out the ruling relations through the interactions between patients and family members, the professional care team, and the managerial level in the hospital. Comparisons between different departments will be provided in the third year. Data gathering techniques include in-depth interview, textual analysis, and participatory observation. This research aims to contribute the social organization of care and the cultural transformation of the professional ethic, and the potential inequalities of the health care reform that sacrifice the patient's needs in the era of new managerialism.
