本研究目的主要在於探討流程管理對於手術室服務效能的影響,為一介入性研究。收集北部某一醫學中心於流程管理介入前後手術室的手術作業活動。研究工具為結構式記錄表,由手術室護理人員記錄預定手術病人在手術流程中之各時間點及異常情況。介入措施為設立排程管理員,對預定手術排程予以追蹤與協調;及建立作業流程標準,以使流程能得到適當的管控。研究工具由7位專家作內容效度檢定;收集3個月的資料為前測,並於介入措施後,再收集3個月的資料為後測,以探討服務效能前後之差異,服務效能指標為:預定手術之病人人次、手術房間使用率、手術排程取消比率、護理人員加班人次與費用及流程中異常次數與延遲時間。所收集的資料以描述性統計、t檢定及卡方檢定進行資料分析。研究結果顯示:流程管理介入後,手術病人人次下降5.55%,其中整形外科及骨科病人人次前後具顯著差異;手術房間使用率介入前後均在87.5%以上,介入後下降0.59%,骨科的使用率下降呈顯著差異(-9.84%);排程取消比率降低1.01%,其中4科前後取消比率呈顯著差異;護理人員加班人次及費用明顯下降,呈顯著差異;流程各步驟花費時間介入前後無顯著差異;流程異常次數介入後降低5.81%,延遲平均時間前後無顯著差異。本研究結果顯示流程管理可以降低流程中的變異,使流程穩定,有效改善作業品質。研究結果可作為醫院、外科系及手術室管理者在行政管理上之參考。
Abstract Title of Thesis:The Impacts of Applying Process Management to the Effectiveness of Operating Room Institution:Graduate Institute of Nursing, Taipei Medical University Author:Chen, Chuen-Jy Thesis directed by:Lu, Meei-Shiow, Professor & Dean, College of Nursing The purpose of this intervention study was to explore the impacts of applying process management on the effectiveness of operating room. Data of the activities in process for elective surgeries were collected in an operating room at a medical center in northern Taiwan. The time of activities in every step for the process will recorded in a constructed sheets by nurses. The process management intervention were to set up a scheduling coordinator and process standards. Data were collected in 3 months both before and after interventions to examine the differences in between. The indicators of effectiveness were: the patient number of operations, the utilization rate of operating rooms, the cancellation rate of schedule, the frequency and cost of nurses’ working overtime, and the frequency of variations as well as the delayed time in process. Data were analyzed by using t-test and Chi-square. The results indicated (1) The number of operations was reduced by 5.55% after intervention; in which, the plastic and orthopedic surgeries showed significant differences. (2)The utilization rate of operating rooms before and after interventions were above 87.50%; after interventions , the utilization rate was reduced 0.59%, in which, the orthopedic surgery showed significant difference. (3) The cancellation rate was reduced by 1.01% , in which ,four departments showed significant differences. (4) The frequency and the cost of working overtime for nurses was reduced to reach significant differences. (5) The time of every step in process had no significant differences. (6)The frequency of process variations were reduced by 5.81%; the delayed time before and after intervention showed no significant difference. The study showed process variations reduced and quality of process improved by process management . The results of this study would provide a reference for hospitals, surgical departments and operating room managers for administration management.