婦產科門診流程管理與最佳化探討─以中部某醫學中心為例

The study of optimal procedure in obstetrics and gynecology clinical management in a medical center using simulation

許雅薇(Ya-Wei Hsu)

指導教授 ： 廖宏昌

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2014年)

摘要

隨著醫學進步與發展，各個醫療單位於醫療硬體設備上皆有完善的設置，而如今社會中無論何種產業大多皆以「以客為尊」為服務導向，各企業經營者最主要的經營目的即為增加顧客滿意度。醫療服務團隊更是如此，病患對於醫療服務品質要求日趨增高，該如何提升醫療照護品質、提高病患對醫院各項服務之滿意程度,成為醫院主要經營方向。
本研究以中部某醫學中心婦產科門診病患作為研究對象，利用離散事件仿真模擬方法依據其婦產科實際看診流程資訊推演出各流程分布情況，建構婦產科病患看診流程模擬架構，並運用反應曲面法配適回歸模型，再利用基因演算法找尋最佳方案，以降低病患平均看診時間以及平均人資成本，提供醫院管理者做為決策依據。
研究結果發現在平均看診流程時間(Y1)，當門診數量為五間時(即為看診時間約7分鍾)、掛號批價櫃檯數量為五個櫃檯(即為掛號批價時間約5分鍾)、領藥櫃檯開立三個櫃檯(即為領藥時間約為8分鍾)以及衛教時間為短(即為衛教時間約為8分鍾)時，能夠使流程時間為最小化。於平均人資成本(Y2)為最佳方案之下，當門診數量為三間、掛號批價櫃檯為三個以及領藥櫃檯為一個時平均人資成本最小。
在理想函數(Y3)之最佳方案為門診數量為三間(即為看診時間約11分鍾)、掛號批價櫃檯為五個櫃檯(即為掛號批價時間約5分鍾)、領藥櫃檯為三個櫃檯(即為領藥時間約為8分鍾)以及衛教時間為短(即為衛教時間約為8分鍾)，此函數採用加權平均之概念，為平均看診流程時間(Y1)以及平均人資成本(Y2)之最佳平衡點，因此，理想函數(Y3)之最佳解為較佳之方案。

關鍵字

門診流程 ； 人資成本 ； 等候時間 ； 流程模擬

並列摘要

With the advances in medical technologies, almost all medical facilities are now equipped with comprehensive medical hardware. While a majority of the industries nowadays are guided by “customer-oriented” service, the main business goal set by every business operator is to improve customer satisfaction. This is more so for medical service teams. As the patients’ demand for quality medical services increases, programs concerning how to improve healthcare quality, and how to enhance patients’ satisfaction with hospital services, which in turn improves patients’ loyalty to the hospital, have become major business operating targets.
The research target of this paper is the OB/GYN outpatient clinic of a medical center in central Taiwan. This paper adopted the Discrete-Event Orientation Simulation method to deduce the overall clinic-visit process based on the real-life clinic visit data to the department, and to construct a clinic-visit process simulation. The improvement factors of the research were used to formulate improvement solutions, of which the optimal solution was found to reduce time spent for the average clinic-visit and to lower average manpower costs. The result is offered to hospital management as a reference base for decision-making.
Findings of this paper show that clinic-visit process time of Average Clinic-visit Process Time Y1 is the shortest, i.e. when there are 5 outpatient rooms (approx. 7 minutes for a clinic visit), 5 registration/cashier counters (approx. 5 minutes for registration and payment), 3 pharmacy counters (approx. 8 minutes for obtaining medicine) in operation, and a Short Time for health education (approx. 8 minutes for health education). Average Clinic-visit Process Time Y1 is the shortest
The best solution for Average Manpower Cost is the genetic algorithm of Y2, i.e. when there are 3 outpatient rooms, 3 registration/cashier counters, and one pharmacy counter in operation, the lowest average manpower cost can be achieved.
The best solution of Ideal Function Y3 is, when there are 3 outpatient rooms (approx. 11 minutes for clinic visit), 5 registration/cashier counters (approx. 5 minutes for registration and payment), 3 pharmacy counters (approx. 8 minutes for obtaining medicine) in operation, and a Short Time for health education (approx. 8 minutes for health education). The Function in question incorporates the idea of weighted average, which is the optimal compromise between Average Clinic-visit Process Time Y1 and Average Manpower Cost Y2. Therefore, the optimal solution of Ideal Function Y3 is a better choice.

並列關鍵字

Outpatient procedure ； Human resource costs ； Waiting time ； Simulation

參考文獻

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