成功推動平衡計分卡過程中之關鍵因素-以某公立區域教學醫院長期照護策略核心團隊為例

Key Factors of Successful Balanced Scorecard Implementation－Using a Long-term Care Strategic Business Unit of a Government Regional Teaching Hospital as an Example

林玉雯(Yu-Wen Lin)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.10148

摘要

隨著全球人口逐年老化，健保制度的大幅變革，加上民眾就醫觀念的改變，醫療機構扮演的角色逐漸加重，使醫院在經營上面臨嚴重的衝擊與困難；在此種情況下醫院必須訂定適當的經營模式，以滿足病患的醫療需求，提供病患高品質的醫療服務，並確保醫院在面對內外部環境的改變時仍能永續經營。醫院為達永續經營目的，運用平衡計分卡為主體之經營模式，協助個案醫院建立以員工學習為基礎，顧客滿意為導向，品質改善為核心之事業經營共同體，並且能有目標、有系統、有組織地不斷進行變革與提升績效。
本研究之目的在於了解推動平衡計分卡過程中有哪些關鍵因素，讓醫院中某策略核心團隊（SBU）成功的提升營運績效及競爭力，達到預定的目標，以及探討推動醫院營運績效活動具體實施內容，找出實施過程中所面臨的挑戰及改善方式。
本研究主要以個案研究方式，採用直接觀察、歷史文件、檔案紀錄、及訪談等方式，進行研究並分析個案醫院在實施過程中的問題、成果及成功推動平衡計分卡過程中之關鍵因素與成員對於平衡計分卡推動看法。平衡計分卡導入時間2004年1月至2006年12月，共計3年，次級資料蒐集期間為2002-2006年，本研究比較實施前(2002-2003年)與實施後(2004-2006年)成果，訪談時間為2007年4月。
本研究結果顯示：
1.平衡計分卡推動下長期照護策略核心團隊在顧客、流程、學習構面均已提升績效，達到目標值，在2006年財務構面達到目標值，顯示出學習、品質、顧客關係構面無形資產提升績效，可以成功轉換成財務有形的成果。
2.參與平衡計分卡推動員工認為平衡計分卡具有功效，平衡計分卡制度在提供同仁之學習成長、醫療滿意度、醫療品質及機構之營運績效方面有提升，並且認為平衡計分卡是很好的管理工具，有共同溝通語言加以整合。推動平衡計分卡制度所面臨之挑戰，可透過績效獎勵制度、適當人力規劃、加強溝通機制，以使平衡計分卡推動順利。
3.除了推動過程、架構、績效指標訂定、制定有價值的策略等結構性因素外，成功推動平衡計分卡過程中之關鍵因素為1.領導者之執行力：包括領導人的重要行為，改變文化讓公司動起來，知人善任，如：充分溝通、增加團隊成員之間友好關係、持續追蹤、以身作則、要有激勵因子、人才培育、與事實貼近；2.運用追蹤概念持續追蹤3.發展成為學習型組織。
因此建議對引進或推行平衡計分卡者，推動平衡計分卡整合各項品管手法的策略管理工具，與績效獎勵制度連結，確實掌握執行之道取得競爭優勢，機構的經營文化與高階管理者的管理方式，可增加此工具之績效提升；針對未來研究者的部份，可深入了解推動此項工具過程中之關鍵因素對於國內醫療院所的適用性及提升績效之因果關係進行研究。

關鍵字

平衡計分卡 ； 長期照護 ； 經營績效 ； 組織變革 ； 領導管理

並列摘要

As the gradually aging of world population, drastic reformation in health insurance system, concept changes in seeking doctors, the role of health care organization becomes more important, making hospitals facing a serious attack and predicament in management. In this situation, hospitals should set a proper management model and offer high quality medical treatment services to satisfy the medical treatment necessary for patients in order to make sure the sustainable operation of hospitals in the changing situations in both inner and outer environment. Using the (BSC) management model can make the case hospital to continuously reform and operate performance systematically and objectively by the establishment of a business operation entity, which is based on the employee learning. Also focus on costumer satisfaction and the persistent quality improvement.
The goal of this research was to understand the key factors to promote operational performance, competition, and how to reach the anticipated objectives by implementing BSC process, and determine the concrete contents of the activities in promoting the hospital performance, to find out the challenge and methods for improvement in the process.
Case study was applied in this research. Data was collected by the method of direct observation, archive documentation and personal interview. The research was focused on the problems, achievements, the key factors by implementing BSC model in the case hospital, and the thoughts from staff members. The BSC was introduced from January 2004 to December 2006. Secondary data were collected from 2002-2006. The result before（2002-2003） and after（2004-2006） using the model was compared. Interview was made in April 2007.
The result of this research revealed:
1. The performance in costumer, process, and learning perspectives of long-term care SBU were promoted to reach the anticipated target value by implementing BSC model. In 2006, the financial perspective reached the target value, which revealed the performance promotion of the invisible properties including learning, quality, and costumer perspectives. These can be transformed into the visible result like the promotion of tangible financial results.
2. Staff members who participated in the BSC model assured the function of BSC. They thought the BSC was useful in employees learning, medical treatment satisfaction, medical treatment quality and the operation performance of the health care organization. They also thought that the BSC is a good management tool that can conform the common communication language. The challenge by implementing BSC can be conquered by using the performance reward mechanism, proper manpower plan, strengthened communication mechanism in order to apply BSC smoothly.
3. In addition to the structural factors including the processes, framework, performance indicator determination and, valuable strategies making, the key factor to implement BSC successfully is a. the execution of the leader; b. continuous follow-up; c. developing the learning organization in order to reach the goal successfully.
In order to get the superior competitive, we recommend conforming each quality control method and linking it to the performance reward mechanism. The operation culture and management method of high-ranked manager can promote the performance. In the future, one can research the applicability of these key factors in the hospitals and their casual relationship with performance promotion.

並列關鍵字

Balanced scorecard ； Long-term care ； Operation performance ； Organization reformation ； Leadership management

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