母乳庫經營策略及績效評估： 台北市立聯合醫院婦幼院區母乳庫個案研究

Management Strategy and Performance Evaluation of Taipei City Hospital Milk Bank(TCHMB) A Case Study

方麗容(Li-Jung Fang)

指導教授 ： 劉順仁

國立臺灣大學/管理學院/高階公共管理組/碩士(2010年)

https://doi.org/10.6342/NTU.2010.00889

摘要

母乳含有最完整且豐富的營養素，可以完全提供出生頭六個月寶寶所需的營養，並持續提供相當的營養成份到至少兩歲以上，是人類寶寶出生後最好的食物來源，也是造物者對寶寶設計的最佳食品。世界衛生組織及聯聯合國兒童基金會於1980 年年共同聲明，當親生母親無法哺育母乳時，應選擇適當來源的母乳來餵食嬰兒。母乳庫的設置也是世界衛生組織積極推廣的婦幼衛生政策，尤其對於罹患重症的高危險嬰兒，當親生母親無法哺育母乳時，提供安全無菌的捐贈母乳更更是當務之急。
本研究採用，蒐集國內外相關文獻，並彙整包括有健康醫療及公衛政策之期刊，母乳哺育與母乳庫相關論文，書籍、專題或演講報告資料、各種相關網站資源，根據所得資料，做深入歸納、詮釋與比較；其次，以個案研究方式，分析台北市立聯合醫院婦幼院區母乳庫發展歷程，探討其經營策略、績效評估，歸納其成功的關鍵因素為1.上級單位的支持及指示。2.清楚的願景與使命。3.專業團隊的執行，使得每一步驟的施行都很專業及踏實。4.同仁不計代價的積極熱心參與。5.符合社會需求，及民意代表與輿論的督促。6.公務預算支持，使得暫時不需考慮財務方面的問題。
為了母乳庫的永續經營及未來來將面對的挑戰，建議應重視下列事項:1.母乳庫未來的層級必須升級至中央，以獨立的預算來運作，並由專任的委員會來管理，如此才能讓母乳庫更快速穩健地成長。2.穩定預算來源:除了公務預算外，可成立基金金會，積極募款，才能永續經營。目前國內由公立醫院以公務預算編列支應，未來建議納入健保給付，以減少公務預算之負擔。3.為因應未來生育率下降，捐乳者可能招募不易，應加強行銷，鼓勵捐乳，同時提高母乳哺育率，持續爭取社會的認同。4.進行母乳相關的各項臨床研究，以實證醫學為根據的臨床照護，推廣母乳及捐贈母乳之觀念。5.建立電腦化的資料庫：母乳庫專用電腦軟體，由專人鍵入捐贈者及受乳者的資料，定期檢視資料，以為修正未來來發展方向的參考。6.促進政府機關以立法來保障母乳庫的相關政策。7.加入國際母乳庫促進協會及參與各項國際會議，隨時與國際接軌，發展國際觀。8.研擬母乳庫績效評估方式，定期稽核，以提昇品質及績效。9.分享母乳庫及衛星站經驗，協助其他地區或國家成立母乳庫。10.成本效益分析，使每一分錢都能妥善運用，並持續檢視母乳庫存在的價值與意義。
目前台北市立聯合醫院母乳庫為全亞洲第一家非營利可處理捐贈母乳的機構。由於設置地點在婦幼院區，母乳庫的作業皆由醫院的編制人員以兼任的方式來支援，需要的經費也由衛生局每年的特別預算來提供。以醫療成果的層面來檢視母乳庫的價值是正面的，但長期在沒有收入的運作之下勢必對母乳庫的未來造成無法預測的衝擊。建議母乳庫未來的層級必須升級至中央，以獨立的預算來運作，並由專任的委員會來管理，如此才能讓母乳庫更快速穩健地成長。

關鍵字

母乳庫 ； 母乳哺育 ； 經營策略 ； 績效評估

並列摘要

Being an abundant source of all essential nutrients, breast milk is the best natural food supply for newly-born human babies. It can serve as the sole source of nourishment for infants up to six months, and can continue to provide high nutritional value for children until at least two years of age. In 1980, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) issued a joint declaration on breast milk, stating: “Where it is not possible for the biological mother to breastfeed, the first alternative … should be the use of human milk from (suitable) sources.” To this end, the promotion of human milk banks has become an important component of the WTO’s maternal and child health policy. For high-risk infants with serious illnesses who have birth mothers unable to produce their own milk, the donation of safe, germ-free breast milk to these banks is an essential service other mothers can provide.
This study was created in part by collecting relevant literature from Taiwan and abroad, and by compiling data from a vast array of sources, including periodicals on health care and public health policy, academic papers, books, special reports, speeches and Internet material relating to breastfeeding and breast milk banks, after which time the data served as the basis for in-depth synthesis, interpretation and comparison. The second component of the study was a single-case report on the breast milk bank at the Taipei City Hospital, Branch for Women and Children, which included an analysis of the bank’s developmental history and an examination of management strategies and performance evaluations. The conclusions of the study stated the following key factors in determining successful milk bank operations: (1) Direction and support from authoritative bodies; (2) Clear missions and visions; (3) Expert staff teams who can execute each step of operations in a practical, professional manner; (4) Enthusiastic, committed staff participation; (5) Ability to meet the needs of society and the demands of public representatives and public opinions; (6) Regular public funding, which allows milk banks to operate without financial concerns for limited periods.
To ensure sustainable management of milk banks in Taiwan while preparing them for future challenges, the following measures should be adopted: (1) Future milk banks should be administered on a national level and operate with an autonomous budget and independent committee supervision to facilitate more rapid, stable growth; (2) Stable budgetary sources: In addition to public funding, financing must come from the establishment of private foundations or active fundraising in order for milk banks to achieve sustainable management. Currently all milk bank funding in Taiwan comes from a portion of public hospital budgets; in the future, a portion of this funding should stem from health insurance premiums in order to alleviate the budgetary pressure on governments; (3) Aggressive marketing and promotional campaigns to counteract potential decreases in future fertility rates that would increase the difficulty in finding milk donors. Breastfeeding awareness should also be made a focus in order to maintain public support of milk donations; (4) Conduct a wide range of clinical studies on milk banks to provide via evidence-based medicine a basis of clinical care that can help promote concepts of breast milk and breast milk donations; (5) Create exclusive-use computer databases in which technical staff can input donor and recipient information that can be regularly accessed for reference during future amendments to developmental strategies; (6) Urge government agencies to legislate fixed policies with regard to milk banks; (7) Create frequent links with other nations by joining international milk bank promotion associations and participating in relevant international conferences in order to develop a clearer global outlook; (8) Conduct performance evaluations and regularly-scheduled audits of milk banks to improve quality and performance; (9) Exchange experiences on management of milk banks and satellite locations to aid the development of local or national milk banks; (10) Perform cost-benefit analyses to ensure all funds are properly spent, while continuously monitoring the calculated worth and significance of milk banks.
The Taipei City Hospital Milk Bank is Asia’s first non-profit agency to collect and store donated breast milk. Because of the bank’s hospital location, all duties are performed by hospital staff, who perform support on a part-time basis. All necessary funding is drawn from an annual special budget provided by Department of Health, Taipei City Govornment. The health care achievements of the bank are used as a tool for ensuring the bank’s positive value in the community. However, the long-term continuation of revenue-free operations will inevitably create unforeseeable obstacles for the bank. This study suggests that the bank will be better served in the future by becoming a centralized, national entity that operates under an autonomous budget and is supervised by an independent committee. Only through such a change can rapid, continuous growth become possible.

並列關鍵字

Human milk banking ； Breast Feeding ； management strategy ； performance evaluation

參考文獻

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