公立教學醫院實施平衡計分卡制度成效之個案研究

葉珍利(Chen-Li Yeh)

指導教授 ： 劉順仁

國立臺灣大學/管理學院/會計學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.00051

摘要

本研究採用個案研究方法，以某公立教學醫院為研究對象，主要目的在評估個案醫院平衡計分卡制度之實施成效，並提出具體的改進意見。平衡計分卡係由美國學者Kaplan和Norton於1992年提出，迄今已為世界釵h知名企業採用，並獲得顯著成果。此外，部分國外醫療組織亦發現平衡計分卡對提昇其績效極有助益。
具體而言，本研究將探討下列三大主題：
(1)醫療單位所設立之目標，內在邏輯是否與平衡計分卡相符？而這些目標是否能達到個案醫院之願景？
(2)實施平衡計分卡之後，醫療單位之績效分數是否有顯著變化？而造成進步或退步之主要原因為何？
(3)由平衡計分卡所產生之績效分數，是否能代表各部門真正之績效？並探討影響績效分數高低之原因。
針對第一個問題，本研究採用策略地圖分析，清楚表達各部門目標及醫院整體目標之因果關係。針對第二個問題，本研究比較各部門前後期實際績效值之變化，並探討其原因。針對第三個問題，本研究利用相關分析、變異數分析及卡方檢定，測試部門分數、自評、互評及長官評分數，以驗證績效計分反映真實績效之能力。
研究結果發現，醫療單位所設立之目標，內在邏輯大致與平衡計分卡相符，然而最後是否能達成願景，仍有待商榷。個案醫院92年指標實際值大部分較91年退步，除了指標設定之相關問題外，SARS是導致執行成效不顯著的主因之一。另外，部門分數V.S.互評、自評V.S.長官評分別呈現高度相關，顯示評分人員的身分、立場和共識會影響評分結果。本研究認為部門分數較能代表各部門真正的績效，然而仍須對其缺失作若干調整。

關鍵字

醫院 ； 績效評估 ； 個案研究 ； 平衡計分卡

並列摘要

The main purpose of the thesis is to assess the effect of a management by objective program which is implemented under the framework of “balanced scorecard” (BSC) in a public teaching hospital. Many prominent business organizations have adopted the BSC methodology and produced remarkable outcomes. Several health care organizations also found BSC useful in enhancing their performances.
The thesis will address three issues.
(1) Are the current goals specified in departmental performance measures of the medical units consistent with overall strategies and objectives of the case hospital? Can these goals achieve the vision of the case hospital?
(2) Are favorable outcomes obtained resulting from the implementation of the BSC framework? If so, what factors drive good outcomes? If not, what factors cause failures?
(3) Does the performance measures employed in the BSC capture the true performance of departments under evaluation? We also explore factors that affect the results of performance measures.
We first address the goal-congruence issue using the tool of “strategy map” proposed by Kaplan and Norton (2000). That is, we will clearly specify the causal relationship among departmental goals along financial, customer, internal process, and learning & growth dimensions. We will investigate whether organizational goals are achieved should departments function based on their targets. Then, we compare the actual performances between year 2002 and 2003 (i.e., performance gap). We will investigate factors that influence the performance gap. To ensure the robustness of the performance measures, we will use correlations, ANOVA and Chi-square test to test the BSC scores, the ranking by the performance evaluation committee, the scores of peer review, and the ranking by top management.
The results indicate that the current goals specified in departmental performance measures of the medical units are consistent with overall strategies and objectives of the case hospital. However, it is uncertain whether these goals achieve the vision of the case hospital. Besides, we generally observe unfavorable outcomes associated with the implementation of the BSC framework. In addition to problems in specifying measures, the Severe Acute Respiratory Syndrome (SARS) outbreak in the year 2003 was critical to unfavorable performances. Further, the BSC scores and the scores of peer review are highly correlated, so is the correlation between the ranking by the performance evaluation committee and the ranking by top management. We find that the status, position, and the extent of consensus may affect the scores. We believe that the BSC scores large capture the true performance of the departments under evaluation. However, the BSC framework implemented by the case hospital requires further revisions to become a more effective tool for performance evaluations.

並列關鍵字

Case Study ； Performance Evaluation ； Hospital ； Balanced Scorecard

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