以品質機能展開法探討醫院服務品質---以某區域醫院血液透析中心為例

中文摘要由於台灣社會、經濟與醫療環境的急遽蛻變，民眾除對醫療服務需求日益殷切外，更對醫療院所提供的服務品質愈加重視，各層級醫療院所在面臨強烈的生存競爭壓力下，莫不致力於追求卓越的品質與服務，期使醫院能保有競爭優勢，成為市場的領先者。當品質已成為醫療競爭重要的關鍵時，品質的策略計畫則更顯為重要。因此，如何「聆聽顧客真正聲音」，精準的找出『服務品質缺口』，建立一套符合顧客需求的服務品質策略，是醫院管理者『立即改善』與『資源再分配』的管理重點。本研究以『PZB服務品質缺口模式』為理論架構之參考，運用品質機能展開法，導入醫院血液透析中心的經營管理，以區域教學醫院為例，經349位血液透析病患的問卷調查，以病患的心聲將所重視的要求品質抽取出來，並以病患期望與實際感受的服務水準做比較，直接衡量兩者的差距。再經由「品質表」製作，清楚的瞭解病患要求品質、服務品質要素及醫院血液透析中心主要業務間的對應關係，擬定業務功能的改善策略與建議。最後將研究結果提供給個案醫院管理主管參考、做成結論及給後續研究者之建議。茲將研究結果摘要如下：一、血液透析病患期望重要度與實際感受滿意度間有缺口。二、血液透析病患要求品質：應用企劃品質表結果發現，透析病患要求品質權重中前五項依序為：護理人員有良好的插針技術（權重2.98）、營養師提供飲食諮詢（權重2.92）、醫師能主動告訴檢查結果（權重2.86）環境清潔沒有滋生蚊蠅（權重2.86）醫師能詳細說明病情及檢查（權重2.84）。三、血液透析服務品質要素：非常重要的有，人員訓練（權重281）、獲得服務的完整性（權重147）、人員的專業能力（權重122）、人員的管理（權重111）及服務的溝通能力（權重108）。四、血液透析中心主要業務：重要的有醫療處置作業標準（權重90）、護理品質管理標準（權重88）、醫療品質管理標準（權重80）、護理部在職教育訓練（權重79）、護理部衛教作業標準（權重77）、感染控制作業標準（權重75）、醫師之專科教育訓練（權重73）。最後，再針對本研究之限制，提出對未來研究的建議。關鍵詞：服務品質、期望品質、實際感受品質、品質機能展開法。

關鍵字

服務品質；期望品質；實際感受品質；品質機能展開法

並列摘要

Abstract OBJECTIVES: The purpose of this study is to understand the gap between medical service and patient expectation in a hemodialysis unit, to establish a SERVQUAL scale system, to analyze the correlation among expected quality, the service quality and the practice of service based on the scale system , and to elaborate strategy for improvement of service. METHODS: A questionnaire survey was performed among 349 hemodialysis patients in a regional hospital. Variables such as the demographic data, utilization of service, decision making of the utilization, method of commuting, traffic distance, traffic time, facilities of the hemodialysis unit, additional services, patient education and counseling, and medical outcomes were analyzed. PZB SERVQUAL was used as the tool to assess the gap of quality of service. Quality function development was performed to elaborate strategy for improvement of service. RESULTS: There is significant gap between the quality of service and patient expectation. The most important quality demands are good nursing technique of needle inserting, nutritional consultation by dietitian, explanation of lab results by physician, hygiene control of unit environment and comprehensive care by physician. The most important parameter for quality of service is personnel training, other important parameters are integrated service, professional capability, personnel management and client communication. The practice of service include standardization of medical intervention procedure, nursing management guideline, criteria for quality assurance, prevention and control of nosocomial infection. CONCLUSION: Strategies for improving the quality of service in hemodialysis unit are provided in nursing department, medical department, utility department and management department. Suggestions related to consolidation policies, hospital administration, medical , nursing department and future research are also provided. Keyword：Service Quality，Expect Quality，Real-FeelQuality，Quality Function Deployment.