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  • 學位論文

應用資料包絡法於內外科病房管理效率差異性分析之研究

Using Data Envelopment Analysis Method to Measure the Efficiency Difference of Medical and Surgical Ward

指導教授 : 胡月娟
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摘要


在總額預算制度實施下, 醫院面臨外部環境的重大改變,本研究以管理的觀點,探討醫院內外科病房單位之管理效率為何,期能提供給管理者有關醫院整體發展,及臨床護理單位管理效率評估之參考,本研究目的為:(1)以資料包絡法評估各個內外科病房之整體效率、純技術效率、規模效率。(2)找出敏感於相對效率評估之投入、產出評量項目。(3)找出投入產出項目變動時對內外科病房相對效率值的影響。本研究為橫斷式的研究,資料選取採回溯性資料分析,即93年至95年中部某醫學中心之內外科病房資料。研究對象為中部某醫學中心之內外科病房11個病房單位,選取33個決策單位。藉由文獻查證及德菲法調查後,選取3個投入變項及9個產出變項。管理效率採用資料包絡法進行內外科病房11個病房單位評估,並分為多元投入項目多元產出項目模式(Charnes,Cooper,&Rhodes;CCR Model),及投入產出間關係為變動規模報酬(Banker,Charnes,&Cooper; BCC Model)兩種模式,以效率值分析、參考組合分析、差額變數分析及敏感度分析進行研究。研究結果發現(一)效率值分析:整體有效率達26個決策單位(Decision Making Unit, DMU),純技術效率及規模效率有29個決策單位;(二)參考組合分析:具整體效率有被參考之單位共有11個決策單位,具純技術效率有被參考之單位共有11個決策單位;(三)差額變數分析:平均技術效率值為0.996,其中有29個(佔88%)決策單位達到相對有效率;(四)敏感度分析:刪除每一個投入變項時,以科別數及病床數在整體有效率改變最多;刪除每一個產出變項時,以約束及感染率在整體有效率改變最多。以資料包絡法之投入導向的CCR模式,得以瞭解93年至95年內外科病房單位管理效率之相對效率,進一步針對無效率單位須改善目標值及幅度,提供相對無效率單位改善之建議,作為日後各年度護理單位資源分配及管理效率評估之參考。

並列摘要


With the rapid change in the social environment and the implementation of global budgets limits of National Health Insurance (NHI) , this research surveys management efficiency of medical and surgical ward in order to provides the guidelines of the whole development in the hospital and the evaluation of management efficiency of the clinical nursing divisions. The objectives of this research include three approaches as follows: (1) to evaluate the total efficiency, pure technical efficiency, and scale efficiency of medical and surgical ward; (2) to find out the input and output evaluation items that are sensitive to relative efficiency evaluation, and (3) to find out the influence on medical and surgical ward when input and output measuring items are changed.Our research is a traversal progress that adopts regression data analysis for data choice and studies on the 11 units of medical and surgical wards and 33 Decision Making Units (DMU) for the medical center in the middle of Taiwan. Our resource data come from the regression data of the medical and surgical ward in the medical center, and then we get 3 input variables and 9 output variables from data collection of references and the investigation of Delphi technique. In the management evaluation, we address the Data Envelopment Analysis (DEA) method to achieve the evaluation of 11 units of medical and surgical wards. The method divides into two models: multiple input items and multiple output items (CCR model) and dynamic scale reward relationship between input and output items (BCC model). Based on these two models, we address our research in the efficient values analysis, reference combination analysis, differential variables analysis and sensitivity analysis.The experimental results show that (1) the efficiency value analysis: there are 29 Decision Making Units (DMUs) in the total efficiency and 28 DMUs in the pure technical efficiency and scale efficiency, respectively, (2) the reference combination analysis: there are 11 DMUs referred in the total efficiency and 11 DMUs referred in the pure technical efficiency, (3) the differential variables analysis: the average technical efficiency value is 0.996 and there are 29 DMUs to reach the relative efficiency, and (4) the sensitivity analysis: the number of departments and the occupational rates change mostly and all of relative efficiency values are greater than 1 in the number of patients when we delete an input variable. In the meanwhile,the restraint and infection rate change mostly in the total efficiency when we delete an output variable.Therefore, using the DEA-oriented CCR model to realize the relative efficiency of medical and surgical wards in 2004 to 2006 is a good way to help the nursing chiefs achieve the best total efficiency of the ward allocation and provides suggestions to refine the non-efficiency units in the goal values and scale.

參考文獻


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