透過組織成員學習績效衡量組織學習率－內視鏡膽囊切除手術之個案研究

Measuring Organizational Learning Rates Based on the Individual’s Learning Performance: A Case Study of Laparoscopic Cholecystectomy Surgery

陳柏樫(Po-Chien Chen)

指導教授 ： 陸怡蕙

共同指導教授 ： 黃芳玫

國立臺灣大學/生物資源暨農學院/農業經濟學研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.02254

摘要

內視鏡膽囊切除手術為一種小但有效率的外科手術，比較於傳統開腹式此手術，病人不僅可縮短住院天數，並可擁有更好的健康恢復能力。從全民健保資料庫中可發現，在1998到2004期間每年大約有一萬名病人接受內視鏡膽囊切除手術,而且人數每年都有增加的傾向。為了降低手術資源的使用量來提供更多的服務給社會大眾,了解醫院如何學習針對此手術做手術成本的控管是必要的。本研究使用Multiplicative與Panel模型來比較台灣九家醫學中心的學習率。 不同於傳統方式直接把組織當成一個體來做學習率的衡量，本研究透過組織成員之學習積效來衡量組織的學習率。此方式不僅可以對外來比較醫院之間的學習率，更可以對內來了解組織內部的學習情況。從本研究的實證解果可發現Panel模型比Multiplicative模型具有更好的估算能力，Panel模型可控制被Multiplicative模型所忽略變數上的特性。實證解果指出年輕的醫師有著較好降低手術成本的學習率，此外，也發現公立醫院對於內視鏡膽囊切除手術成本控管的學習能力比私立醫院好。同時也了解內視鏡膽囊切除手術不管在南台灣還是北台灣的醫學中心都已經達到普遍化了。

關鍵字

組織學習 ； 學習率比較 ； 學習曲線 ； 內視鏡膽囊切除手術 ； 手術成本評估 ； 醫療能力

並列摘要

Laparoscopic Cholecystectomy (LC) is one of small but efficient surgeries. Patients receiving LC surgical method are not only benefited by its convenience of reducing the length of hospital stays but also having better health rehabilitation compared to the traditional Open Cholecystectomy (OC) procedures. According to Taiwan National Health Insurance agency, an average number of more than ten thousand people have received LC surgeries every year from 1998 to 2004, and this number has tendency to increase every year. In order to reduce medical resource usages for providing more LC surgical service to the publics, it is important to understand how well the hospitals could learn to manage their LC surgical cost reduction.An introduction of two research methods: Multiplicative and Panel models are applied to make cross organization learning rate comparison. Different from the conventional way of directly measuring the organization as a unique entity, we measure the organizational learning rates from nine medical centers based on the population of the organization members. This research method not only compares the organization’s learning performance but also feasible to insight the member’s learning behavior within the organization.Our empirical results show a better estimation of the panel method for controlling more variable characteristics ignored by the multiplicative model. Our model tells that junior surgeons could result in better learning performance for using less medical resources during the operations. Moreover, public medical centers indeed generate better learning outcomes than the private ones for learning to reduce more surgical expenses. However, our research also implies that the LC surgical methods are well implemented in Taiwan in regardless of the geographical difference.

並列關鍵字

Organizational learning ； Laparoscopic Cholecystectomy ； Learning curve ； learning rate comparison ； Surgical cost assessment ； Clinical competence

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