以洗腎病人為中心的服務設計

A Patient Centered Service Design for Hemodialysis

陳文萱(CHEN, WEN SHUAN)

指導教授 ： 林則孟

國立清華大學/科技管理學院/經營管理碩士在職專班/碩士(2015年)

https://doi.org/10.6843/NTHU.2015.00320

摘要

長久以來醫界已建立了一個「以病人為中心」的中心思想和任務宣言，然其以「以病人為中心」的概念，是以醫療供給者的角度出發，一切作為是以圍繞著醫師做的事情為中心。本研究從洗腎病人及其家屬的角度出發，經由洞察他們的動機和真正需要，並納入病人及其家屬成為共同創作者，讓病人及其家屬也能當家作主，共同設計一個「以病人為中心」的洗腎服務。

　　本研究依循英國工業設計協會(UK Design Council)所提倡的雙鑽石模型(4Ds)，並將服務設計流程分成以下兩個主軸：
一、 探索及定義：透過價值主張畫布定義洗腎服務的「價值主張」(Value Proposition)。經過大量對洗腎服務的洞察、對洗腎服務利害關係人的訪談及資料研讀，研究成員定義「滿足洗腎病人及病人家屬的需求」及「解決洗腎病人及病人家屬困擾(或阻礙) 」的價值主張。

二、 創意發想及傳遞：運用服務設計的系統化流程及工具，將定義的洗腎服務的價值主張，雕塑成具備市場競爭力的洗腎「服務雛型」。本研究用一種新的思考方式，完全以顧客為中心，按照時間序列一步一步的剖析服務流程，從基本的功能面一直深入到精神層面；研究進行中大量的共同創作，讓多元的設計更能對準洗腎病人及其家屬的需求。服務藍圖將已經成熟的創新「服務草案」模擬成實際的運作模式，以呈現創新的服務草案所需的技術、人力、資源及合作廠商，並驗證創新草案市場的可行性。藍海策略和策略草圖，幫助我們形塑創新的草案以具備市場競爭力，也檢驗新創的服務草案是否禁得起市場考驗，最後提出具備市場競爭力的洗腎「服務雛型」。

本研究經過探索、定義、創意發想和傳遞四個服務設計流程後，提出四個「服務雛型」，並歸納以下三點結論：1. 本研究以病人為發點與傳統以醫療供應者角度為出發點的設計思維，儘管同樣是揭櫫「以病人為中心」的理想，但由於出發點不同，卻有相當大的差異。2. 以洗腎病人為中心為出發，並創造病患最大的價值時，醫療機構同時也能降低經營成本，並得到更好的名聲及獲得更多顧客的信賴。3.傳統服務流程有很多服務斷裂點，本研究之設計流程可以發現這些服務的斷裂點，並採取補足斷裂點的設計。

關鍵字

價值定位 ； 服務設計 ； 洗腎 ； 血液透析 ； 以病人為中心

並列摘要

Medical profressionals had well established a concept of idea and mission statement called "Patient-Centered", and it was established on the medical provider's views, that everything were all around the center of physicians. In this study, we started with the perspective of dialysis patients and their families, dipping deeply into their insight motivations and real needs, and included patients and their families as co-creators. Finally, patients and their families would become the masters to design a patient centered dialysis services.

This study followed the advocates of Double Diamond model of UK Design Council, and divided it into the following two main themes

First at all, Discover and Define:
We define the Value Proposition of hemodialysis services by using the "Value Proposition Canvas" . After a extensive work of observating the hemodialysis process, interviewing with stakeholders and explorating from internet social network, we define the value proposition of what dialysis patient and their families needs and how to solve the dialysis patient and their families distress (or hinder).

Secondly, Develop and Deliver:
The value of hemodialysis services that we had been defined were then designed to be a competitive prototype, sculptured by using a series of service design tools systematically. In this study, we use a way of customer-centered design thinking, which were step by step and time series analysis processes, to catch deep insight customes’s needs socially and emotionally; In this study we conducted with a large number of co-creations and created several “innovation service drafts”, in result of diverse designs were more aligned to the needs of dialysis patients and their families. We sketched out services Blueprint in order to simulate these innovation service drafts in a actual operation condition, and to understand the requirement of technology, manpower, resources and partnerships for this innovation service, and then to verify the feasibility in real world. The Blue Ocean strategy would help us to shape these innovation service drafts to be a competitive one in the market, and it could examine whether the service drafts withstand the challenges in market. Finally we delivered the market fitted service prototypes.
In this study we used Discover, Define, Develop and Deliver processes– based on the stages of the Double Diamond, the Design Council’s simple way of mapping the design process, and created four prototypes for the hemodialysis service. And finally, we concluded the following three conclusions: First at all, there is a considerable difference between this study and traditional providers based design thinking, although they all advocated the same ideal of "patient-centered". Secondly, the health care organizations will retrench their expenses, as well as get a better reputation and customers trust, if the designs focused on the patient-centered and created maximum value for the patients. The third, there are many breaking points in the traditional hemodialysis services, in this study, with the Discover, Define, Develop and Deliver processes, we would find the breaking point and try to make up these break points.

並列關鍵字

Value Proposition ； Service Design ； 4Ds ； CKD ； Chronic Kidney Disease ； Hemodialysis

參考文獻

石耀堂，2007 ，“以病人為中心的倫理體系建構：互動中創造價值”。

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