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Abstract：
This study proposes a multi-level model of institutional innovation in the healthcare sector-in other words, field-level institutional change pressures that start as network-level institutional innovation by hospitals and government for their organizational performance, with an emphasis on the effect of organizational-level construct-knowledge creation capabilities. A case study using in-depth interviews and a historical inquiry approach has been used to qualitatively analyze our cases during the development of Taiwan\'s National Health Insurance (NHI). Our results propose a multi-level explanation of institutional innovation by showing how field-level institutional change pressures can stimulate the government\'s institutional innovation at the network level. Moreover, knowledge creation capabilities may positively influence the government hospitals\' ongoing institutional change pressures induced institutional innovation activity for their performance at the organizational level in an institutional setting. This study contributes to health organization management researchers and administrators by developing explanations of institutional innovation and creating a much-needed multi-level insight into hospital behavior in the highly institutionalized healthcare sector.
摘要：
这项研究提出了一个多层次的医疗行业制度创新模型-换句话说，领域层面的制度变革压力始于医院和政府对其组织绩效的网络层面制度创新，强调组织层面建构知识创造能力的影响。在台湾国民健康保险（NHI）发展过程中，采用了深入访谈和历史调查方法的案例研究，对我们的案例进行了定性分析。我们的结果通过展示场级制度变革压力如何在网络层面刺激政府的制度创新，提出了对制度创新的多层次解释。此外，知识创造能力可能会积极影响政府医院\'正在进行的制度变革压力诱导的制度创新活动，以提高他们在机构环境中组织层面的绩效。本研究通过对制度创新的解释和对高度制度化的医疗保健部门中医院行为的急需的多层次见解，为卫生组织管理研究人员和管理人员做出了贡献。
