持續性品質政善(CQI)理論及實證研究－以長庚醫院醫療供應作業改善為例

Continuous Quality Improvement (C.Q.I.) Theory and Empirical Study: An Example for Chang-Gung Memorial Hospital's Supporting Service Improvement

莊逸洲(Yi-Chou Chuaug) ； 吳振隆(Chen-Lung Wu)

《中華民國公共衛生學會雜誌》 12卷3期 (1993/09) Pp. 291-311

https://doi.org/10.6288/JNPHARC1993-12-03-08

摘要

美國醫療品管活動的發展，由傳統的『品質保證』(Q.A., QUALUTY ASSURANCE)演進至目前的『持續性品質改善』(C.Q.I., CONTNUOUS QUALITY IMPROVEMENT)，其主要精神在強調“積極地不斷玫善來提昇品質”，而不僅是“消極地檢討異常來維持品質”。
『醫療品管』無論其概念(CONCEPT)或導入實務(APPROACH)均源自『產業模式』(INDUSTRIAL MODEL)，而其與產業模式最主要的不同即是永遠把病人擺在第一順位，優先考慮。在醫療品質改善計劃裡，醫院一方面應依其宗旨與經營哲學提供以病人爲中心的卓越醫療照護品質，一方面在執行醫療照護的過程中亦應不斷地去改善作業來節制醫療成本。
長庚醫院從創院迄今，始終抱持“改善永無止盡”的精神，在日常工作中即不斷進行各項作業改善，而最近的醫療供應作業改善，只是過程中的一例。醫療供應作業改善內容包括（一）『供應品』之檢討改善：以『即棄式』(Disposable)取代目前『回收使用』(Reusable)材料並依每項醫療處置別整理需使用之材料，再透過個別材料的合併、簡化、取代及預先組合成單一『處置包』(PACKAGE)等作業，進而設定品質標準、檢驗規範、進行成本分析後再交專業製造商製作供應。（二）『供應作業流程』之檢討改善：包含材料之開發引入、存量管制、採購、檢驗、付款、收料及自動補充等事務作業電腦化。經此改善後，醫療供應作業人力由41人精簡爲13人(-68.3%)，作業空間需求由586坪減爲186坪(-8.3%)，每月材料成本由646萬元減爲421萬元(-34.8%)，另節省設備投資229萬元；同時供應品質獲得雙重確保、作業效率提高、庫存成本亦降低。惟如上述，醫療供應作業改善只是本院各項改善作業的一部份，其目前的改善成果對本院追求“精益求精，止淤至善”的理想而言，不過是中間過程。

並列摘要

The main purpose is to emphasize the idea of ”ENHANCED MEDICAL QUALITY THROUGH ACTIVE & CONTINUOUS IMPROVEMENT”, not that of ”MAINTAINED MEDICAL QUALITY THROUGH ELIMINATING VARIATION PASSIVELY”, when the development of medical quality evolves into the current continuous quality improvement (CQI) from the traditional quality assurance (QA) in the U.S.A.
Either the concept or practical experience of medical quality management comes from those of the industrial model. Considering the patients as the first priority forever is the medical models major difference from the industrial model. In the planning of medical quality improvement, on the one hand, hospitals must provide excellent medical services through concentrating on the patients services with regard to their mission statements & management philosophy. On the other hand, hospitals must also contain health care costs through improving the process continuously in the implementation of health care.
Supporting service improvement is just one example of the process improvement, which is done routinely in our hospital under the mission standard of ”IMPROVEMENT IS ENDLESS”, which our hospital sticks to since the establishment. The first step of the supporting service improvement is improvement of supplies selection. Namely, we use disposable supplies to replace reusable ones and we assemble different individual packages, which contain the necessary supplies for different procedures through ways of mergence, simplification & replacement. Then we cooperate with supplies companies to produce those packages after spelling out quality standard, inspection guideline & cost analysis. Secondly, the improvement on the process of supplies is our target, for example, including the computerization of development of materials, inventory control, purchasing, inspection, billing , receiving, & automatic filling. The result is that the total NO. of personnel in the supplies department reduce to 13 from 41 (DECREASING PERCENT 68.3%), and that space requirements reduce to 186 PYNG from 586 PYNG (DECREASING PERCENT 68.3%), and that supplies cost per month is NT$4.21 million from NT$6.46 million. In addition, the facility investment of NT$2.29 million is saved. In summary, double assurance on quality, increased efficiency & reduced inventory costs are achieved. As we mentioned earlier, supporting service improvement is just one part of our total quality management. The current improvement resulting just one step in our endless journey of ”IMPROVEMENT IS ENDLESS”.

並列關鍵字

Q.A. Quality Assurance C.Q.I. Continuous Quality Improvement Managed Care FOCUS/PDCA