目的 醫療機構變革，牽動組織與其內在成員的互動 與協定；在對組織期待落差的情境下，成員於認知 上衍生心理契約違背之感。是以，本研究從組織與 主管兩方面，檢視成員自覺組織支持及上司－部屬 關係品質與成員感知心理契約違背的關聯，並進而 探討主動變革職責感受的中介效應。 方法 研究對象為空軍醫療單位成員，共計238位。 為避免資料同源偏差，研究設計上，採兩階段問卷 調查。兩階段皆填寫的有效問卷為172份。 結果 由複迴歸結果顯示，上司－部屬關係品質及自 覺組織支持皆與個人感知心理契約違背具顯著負向關 聯；同時，主動變革職責感受分別中介此兩者與感知 心理契約違背的關聯。 結論 面對變革，當組織不符成員期待，藉由組織 支持及上司關切與訊息傳達，成員可體認變革的 需求，願意共同承擔改變的必要，由而降低感知 心理契約違背之感。（澄清醫護管理雜誌 2019； 15（2）：30-40）

Purposes Restructuring of medical institutions affects interaction and consensus between an organization and its members. Gaps in expectations between an organization and its members lead to perceived psychological contract breaches. The present study determined the association between leader-member exchange quality, perceived organizational support, and perceived psychological contract breaches with members at organizational and supervisory levels. In addition, the mediating effect of perceived responsibility for constructive change was investigated. Methods The study included 238 medical personnel in 15 air force medical units. Questionnaires were distributed at 2 time points to avoid single-source bias in the data. A total of 172 valid questionnaires were collected from the 2 time points. Results Multiple regression results showed that perceived organizational support and leadermember exchange quality were significantly negatively correlated with psychological contract breach. At the same time, those negative correlations were mediated by perceived responsibility for constructive change. Conclusions When an organization does not fulfill the expectations of its members during a period of restructuring, organizational support and a leader’s concern and dissemination of information can enable members to accept the need for restructuring and be willing to participate in change, thereby reducing perceived psychological contract breaches. (Cheng Ching Medical Journal 2019; 15(2): 30-40)