本研究探討台灣醫院高階管理團隊（TMT）的特質、醫院規模、組織文化取向、TMT成員的環境永續與數位轉型策略重點、與環境永續導向與數位轉型策略、增強醫療品質能力與醫院競爭優勢之間的關係。本研究基於上層團隊理論認為TMT成員的環境永續導向與數位轉型策略重點、與環境永續導向與數位轉型策略、增強醫療品質能力與醫院競爭優勢受到TMT特徵、醫院規模、組織文化取向等內部因素的影響。先前的許多研究已經調查了企業高階管理團隊特徵、企業規模和組織文化取向如何影響企業績效。然而，關於醫院高階管理團隊如何影響醫院競爭優勢發展的研究仍然有限。
本研究使用醫院院長填寫並回傳的問卷調查資料來調查這種關係。 TMT的策略重點包括環境永續導向與數位轉型，永續發展策略包括環境永續與數位轉型，永續發展能力包括提升醫療品質，永續發展競爭優勢包括病患滿意度和塑造醫院正向形象。結果顯示，TMT成員數目、醫院院長是否擁有碩士或博士學位、TMT成員性別異質性、TMT成員教育異質性、TMT年資異質性、TMT平均年資、TMT管理教育異質性、醫院院長年資、醫院規模與TMT的策略重點、永續發展策略、永續發展能力、永續發展競爭優勢之間不存在相關性。綠色環保、以病人為中心的組織文化取向與TMT的策略重點、永續發展策略、永續發展能力、永續發展競爭優勢則有顯著的相關性。
當醫院的組織文化秉持綠色環保與以病人為中心原則時，1.綠色環保的組織文化取向，會體現節能減碳，並提倡與自然環境、地球共存。 2、以客戶為中心的醫院組織文化將病人視為最重要的關鍵利益相關者，與企業社會責任（CSR）密切相關。在醫療永續管理上，我們需要關懷所有相關利害關係人並實踐公開、透明、公正的治理，包括所有病患及其家屬、醫院組織內同仁、合作供應商、醫院所在地社區民眾等。因此，秉持綠色環保與以病人為中心組織文化導向的醫院高階管理團隊，將聚焦綠色環保、降低碳排放、智慧AI數位轉型等，進而制定相關環境永續導向與數位轉型策略，培育提升醫療品質的能力，進而在建立醫院正面形象與高病患滿意度方面取得了競爭優勢。
本研究填補了學術文獻的空白，對醫院高階管理團隊特徵、醫院規模和組織文化取向對醫院在醫療保健可持續性方面建立競爭優勢的能力的影響提供了寶貴的見解。研究結果可以幫助院長與醫院高階經營團隊確定內部組織文化的方向，以提高醫院醫療可持續性的績效。

This study explores the relationship between the characteristics of Taiwan's hospital top management teams (TMTs), hospital size, organizational culture orientation, TMT members' environmental sustainability-oriented and digital transformation strategic focus, environmental sustainability-oriented and digital transformation strategy, and the capability to enhance medical quality and competitive advantage for hospitals. Based on the upper echelon theory, this study argues that TMT members' environmental sustainability-oriented and digital transformation strategic focus and capability to enhance medical quality and competitive advantage are influenced by internal factors such as TMT characteristics, hospital size, and organizational culture orientation. Many previous studies have investigated how top management team characteristics, firm size, and organizational culture orientation affect firm performance. However, research on how hospital top management teams influence the development of hospital competitive advantage remains limited.
This study investigated the relationship using questionnaire data completed and returned by hospital superintendents. TMT's strategic focuses include environmental sustainability-oriented and digital transformation. Sustainable development strategies encompass environmental sustainability-oriented and digital transformation, while sustainable development capabilities involve enhancing medical quality. Additionally, sustainable development's competitive advantages consist of patient satisfaction and shaping a positive image of the hospital. The results indicated that there was no correlation between the number of TMT members, whether the hospital superintendent held a master's or doctoral degree, gender heterogeneity among TMT members, educational heterogeneity of TMT members, TMT tenure heterogeneity, average TMT tenure, TMT management education heterogeneity, hospital superintendent tenure, hospital size, and TMT's strategic focus, sustainable development strategy, sustainable development capability, and sustainable development competitive advantage. Green and environmentally friendly, customer-centered organizational culture orientations significantly correlate with TMT's strategic focus, sustainable development strategy, sustainable development capabilities, and competitive advantages.
When the hospital's organizational culture follows the principles of green environmental protection and customer-centeredness 1, the green organizational culture orientation will reflect energy conservation and carbon reduction while promoting coexistence with the natural environment and the earth. 2. A customer-centric hospital organizational culture views patients as the most important key stakeholders and connects closely to corporate social responsibility (CSR). Regarding sustainable healthcare management, we must care for all relevant stakeholders and practice open, transparent, and fair governance, including all patients and their families, colleagues within the hospital organization, cooperative suppliers, and community residents where the hospital is situated. Therefore, the hospital's top management team, which embraces green and environmental protection alongside customer-centered organizational culture orientation, will concentrate on green environmental protection, reducing carbon emissions, smart AI digital transformation, etc. They will then develop relevant environmental sustainability-oriented and digital transformation strategies, enhance the capability to improve medical quality, and secure a competitive advantage in establishing a positive hospital image and achieving high patient satisfaction.
This study fills a gap in the academic literature. It provides valuable insights into the impact of hospital top management team characteristics, hospital size, and organizational culture orientation on the hospital's ability to build a competitive advantage in healthcare sustainability. The research results can help hospital directors and senior management teams determine the direction of internal organizational culture to enhance the performance of hospital medical sustainability.

1.
Dissertation Validation Letter ................................................................................... i
Acknowledgements ................................................................................................... ii
摘要........................................................................................................................... iii
Abstract ..................................................................................................................... v
2.
Chapter 1: Research Overview..................................................................1
1.1 Research Background..........................................................................................1
1.2 Research Motivation............................................................................................5
1.3 Research Purpose ................................................................................................6
Chapter 2 Literature Review ……………………………………………….....9
2.1 Upper Echelon Theory………………………………………………………...10
2.2 Characteristics of the Top Management Team………………………………..11
2.2.1 Heterogeneity of Top Management Team…………………………………..12
2.2.2 Size of Top Management Team……………………………………………..14
2.2.3 Educational Level of Superintendent…………………………..…………...15
2.2.4 Management Education Heterogeneity of Top Management Team ………..16
2.2.5 Educational Heterogeneity of Top Management Team……………………..17
2.2.6 Average Tenures of Top Management Team ………………………………18
2.2.7 Gender Heterogeneity of Top Management Team …………………………18
2.2.8 Tenure of Superintendent…………………………………………………...20
2.2.9 Tenure Heterogeneity of Top Management Team…………………………..20
2.3 Hospital Size and Corporate Social Responsibility…..……………………….21
2.4 Green Organizational Cultural Orientation ……………………………...…...22
2.4.1 Customer Centric Orientation………………………………………..……...23
2.5 Twin Transformation of Environmental Sustainability-oriented and Digital….24
2.6 The Conceptual Framework………………………..………….………………42
2.7 The Constructs under Theoretical Foundation………………………………...42
2.7.1 TMT Strategic Focus ………………………………………………………..43
2.7.2 Hospital Strategy ………………………………………….………………...46
2.7.3 Hospital Capability …………………………………...……………………..46
2.7.4 Hospital Competitive Advantage …………………………………………...48
2.8 Transformation ……………………………………………………………......50
2.8.1 Environmental Sustainability-Oriented Transformation and Digital Transformation……………………………………………………………….51
2.8.2 TMT`s Strategic Focus on Environmental Sustainability-Oriented Transformation……………………………………………………………….53
2.8.3 Hospital's Strategy for Environmental Sustainability-Orientated Transformation ………………………………………………………………54
2.8.4 TMT`s Strategic Focus on Digital Transformation …………………………55
2.8.5 Hospital's Strategy for Digital Transformation……………………………...55
2.9 Hospital Capability of Enhancing Medical Quality …………………………..56
2.9.1 Integrating Environmental Sustainability-Oriented and Digital Transformation Positively Impacts the Capability of Enhancing Medical Quality………………………………………………………………………..57
2.10 Hospital`s Competitive Advantage…………………………………………..60
2.10.1 Hospital`s Image Building…………………………………………………61
2.10.2 Hospital`s Patient Satisfaction……………………………………………..61
2.11 Introducing Issues Related to Hospitals……………………………………...62
2.11.1 Top Management Team (TMT) and Team Resource Management (TRM) in
The Hospital……………………………………………………………….62
2.11.2 CSR in the Hospital………………………………………………………...63
2.11.3 Types of CSR in the Hospital………………………………………………65
2.11.4 Motivation Principles of CSR in the Hospital……………………………...66
2.11.5 Dimensions of CSR in the Hospital………………………………………...67
2.11.6 ESG in the Hospital………………………………………………………...69
Chapter 3: Model and Hypotheses............................................................71
3.1 The Proposed Research Model……........................................................71
3.2 Hypothesis Development...................................................................................77
3.2.1 TMT Characteristic………………………………………………………….77
3.2.1.1 TMT Size and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation ………………………………………………….78
3.2.1.2 TMT Size and TMT's Strategic Focus on Digital Transformation………...79
3.2.2.1 TMT Gender Heterogeneity and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation ……………………………..80
3.2.2.2 TMT Gender Heterogeneity and TMT's Strategic Focus on Digital Transformation ……………………………………………………...…….81
3.2.3.1 TMT Education Heterogeneity and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation ……………….81
3.2.3.2 TMT Education Heterogeneity and TMT's Strategic Focus on Digital Transformation …………………………………………………………....82
3.2.4.1 TMT Tenure Heterogeneity and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation …………………………………..83
3.2.4.2 TMT Tenure Heterogeneity and TMT's Strategic Focus on Digital Transformation ……………………………………………………………83
3.2.5.1 TMT Average Tenure and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation …………………………………..84
3.2.5.2 TMT Average Tenure and TMT's Strategic Focus on Digital Transformation…………………………………………………………….84
3.2.6.1 TMT Management Education Heterogeneity and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation …………….85
3.2.6.2 TMT Management Education Heterogeneity and TMT's Strategic Focus on Digital Transformation………………………………………………….....86
3.2.7.1 Superintendent`s Tenure and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation …………………………………..86
3.2.7.2 Superintendent`s Tenure and TMT's Strategic Focus on Digital Transformation………………………………………………….…………87
3.2.8.1 Superintendent's Educational Level and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation ………………….87
3.2.8.2 Superintendent's Educational Level and TMT's Strategic Focus on Digital Transformation ……………………………………………………………88
3.3 Hospital Size ………………………………………………………………….89
3.3.1 Hospital Size and TMT's Strategic Focus on Environmental Sustainability
Oriented Transformation……………………………………………….…….90
3.3.2 Hospital Size and TMT's Strategic Focus on Digital Transformation ………91
3.4 Organization Culture Orientation ……………………………………………..92
3.4.1 Green Organization Culture Orientation and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation …………………...92
3.4.2 Green Organization Culture Orientation and TMT's Strategic Focus on Digital Transformation ……………………………………………………………..93
3.5 Customer-Centric Orientation that Prioritizes Patient Satisfaction……………94
3.5.1 A Customer-Centric Orientation and TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation…………………………………….94
3.5.2 A Customer-Centric Orientation and TMT's Strategic Focus on Digital Transformation……………………………………………………………...95
3.6 The TMT's Strategic Focus and the Hospital's Strategies……………………..96
3.6.1 TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation and the Hospital's Strategy for Environmental Sustainability-Oriented Transformation……………………………………………………96
3.6.2 TMT's Strategic Focus on Environmental Sustainability-Oriented Transformation and the Hospital's Strategy for Digital Transformation……96
3.6.3 TMT's Strategic Focus on Digital Transformation and the Hospital's Strategy for Environmental Sustainability-Oriented Transformation……………….97
3.6.4 TMT's Strategic Focus on Digital Transformation and the Hospital's Strategy for Digital Transformation………………………………………….98
3.7 Hospital`s Strategy and the Hospital`s Capability………………………….....99
3.7.1 Hospital`s Strategy for Environmental Sustainability-Oriented Transformation and the Hospital`s Capability of Enhancing Medical Quality………………99
3.7.2 Hospital`s Strategy for Digital Transformation and the Hospital`s Capability of Enhancing Medical Quality……………………………………….100
3.8 Hospital's Capability of Enhancing Medical Quality Mediating the Environmental Sustainability-oriented Transformation and the Competitive Advantage of Image Building……………………………………………..101
3.9 Hospital's Capability of Enhancing Medical Quality Mediating the Environmental Sustainability-oriented Transformation and the Competitive Advantage of Patient Satisfaction………………………………………....102
3.10 Hospital's Capability of Enhancing Medical Quality Mediating the Digital. Transformation and the Competitive Advantage of Image-Building……102
3.11 Hospital's Capability of Enhancing Medical Quality Mediating the Digital Transformation and the Competitive Advantage of Patient Satisfaction…...............................................................................................................................................................................................................................103
Chapter 4 Research Design / Method………………………………………...105
4.1 Overall Design………………………………………………………………..105
4.2 Sampling Frame……………………………………………………………...105
4.3 Variables………………………………………………………………….......109
4.3.1 Dependent variables……………………………………………………..109
4.3.2 Independent variables……………………………………………………113
Chapter 5 Data Analysis and Research Results…………………………….116
5.1 Analytical Approach………………………………………………………….116
5.1.1 Statistical analysis methods………………………………………………...117
5.1.1.1 Descriptive Statistics……………………………………………………..117
5.1.1.2 Inferential statistics………………………………………………………117
5.2 Model Presentation …………………………………………………………..118
5.2.1 Descriptive analysis result………………………………………………….118
5.3 Data Quality………………………………………………………………….121
5.3.1 Face Validity………………………………………………………………..121
5.3.2 Common Methods Bias ……………………………………………………121
5.3.3 Construct Reliability & Validity……………………………………………122
5.3.3.1 Reliability Analysis of TMT's Strategic Focus (TSF)……………..……122
5.3.3.2 Reliability Analysis of Hospital Strategy (HS)…………………………..123
5.3.3.3 Reliability Analysis of Hospital Capability (HC)…………………..……125
5.3.3.4 Reliability Analysis of Hospital Competitive Advantage (HCA)………..126
5.3.4 The influence of TMT characteristics, the superintendent characteristics, and. the hospital characteristics on TMT's strategic focus ………………......................................................................................................126
5.3.4.1 Analysis of the differences between the TMT characteristics, the. superintendent characteristics, and the hospital characteristics on TMT's strategic focus on Environmental Sustainability-Oriented Transformation and Digital transformation………………………………………….……127
5.3.5 TMT's Strategic Focuses, Hospital's Strategies, Hospital's Capability, and Hospital's Competitive Advantages………………………………………..136
5.3.5.1 TMT's Strategic Focuses` effect on Hospital's Strategies………………..137
5.3.5.2 Hospital's Strategies effect on Hospital's Capability……………………..138
5.3.5.3 Analyze the Mediation Effect of the Hospital's Capability as a Mediator in. the Relationship between the Hospital's Strategy and the Hospital's Competitive Advantage…………………………………………………..138
5.4 Hypothesis verification results……………………………………………….146
5.4.1 Variance Inflation Factor (VIF) and Correlation Matrix Analysis………146
5.4.2 Results of the Hypotheses……………………………………………….147
5.5 Discussion……………………………………………………………............152
Chapter 6 Conclusion and Implications...............................................................159
6.1 Conclusion.......................................................................................................159
6.1.1 Factors Affecting Hospitals' Sustainable Competitive Advantage…………159
6.1.2 Dual Transformation of Environmental Sustainability-oriented and Digital….160
6.2 Theoretical Implications……………………………………………………...161
6.3 Managerial Implications……………………………………………………...163
6.4 Limitations…………………………………………………………………...165
6.5 Future research.......................................................................................................166
References..............................................................................................................167
Appendix …………………………………………………………………………...236

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