醫院品質管理活動數量與績效關係之研究

Relationship between Number of Quality Management Activities and Hospital Performance in Taiwan

蔡嘉韡(Chia-Wei Tsai) ； 王佳惠(Chia-Hui Wang) ； 郭乃文(Nai-Wen Kuo)

《北市醫學雜誌》 3卷5期 (2006/05) Pp. 480-489

摘要

目的：民國八十四年全民健康保險開辦後，醫療環境驟變，各醫療機構唯有靠良好的品質與服務才能吸引病患。因此，國內各醫療機構在全民健保開辦之前後數年，紛紛開始推展各類之品質管理活動（如：全面品質管理、品管圈、臨床路徑、ISO認證、提案制度、流程再造、5S運動、實證醫學、學習型組織、六個標準差與醫療品質指標計畫等）。因此，本研究希望能透過長期觀察，來探討醫院品管活動數量與醫院經營績效之關係。方法：本研究以國內地區教學級以上128家醫院為研究對象，以問卷方式調查醫院過去十一年內（民國83年至民國93年）曾推動之品質管理活動種類、推動起始時間及推行現況、及高階主管針對品管活動對醫院績效影響之主觀評估；問卷回收率達54.68%。並以資料包絡分析法計算醫院績效值，再以GEE(generalized estimating equation)迴歸模式來分析品質管理活動數量與醫院績效之縱貫性關係。結果：本研究的主要發現如下：（一）醫療品質指標計畫與臨床路徑為目前醫院最普及的品質管理活動。（二）品管活動數越多，對醫院績效有顯著的提升作用。結論：本研究結果顯示，品質管理活動能有效地提升醫院的營運績效，而且採用的品管活動愈多，醫院的營運績效也會隨之提升。

關鍵字

品質管理活動 ； 營運績效 ； 縱貫性研究

並列摘要

Background and Purpose: After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan increased dramatically. Therefore, for attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, development of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc. However, no empirical study has been conducted for examining the relationship between quality management activities and hospital performance. Thus, this study examined the relationship between number of quality management activities and hospital performance longitudinally. Methods: The study samples include 128 regional (and above) teaching hospitals in Taiwan. A questionnaire was sent to each hospital for collecting related information. The response rate was 54.68%. All the data collected was linked to the National Hospital Survey conducted by the Department of Health, the Executive Yuan for analysis. Hospital performance was represented by DEA (data envelopment analysis) scores. GEE (Generalized Estimating Equation) regression was applied to analyze the longitudinal impact of number of quality management activities on hospital performance. Results: (1) The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now. (2) The more the hospital quality management activities, the higher the physician productivity and hospital performance. Conclusion: In conclusion, the results proved that number of quality management activities have positive effects on hospital performance. In other words, promoting health care quality will lead to better hospital performance. Therefore, we suggest hospital administrators to design a long term plan to promote quality management activities continuously.

並列關鍵字

quality management activities ； hospital performance ； longitudinal study