限制理論用於醫療材料存貨管理之研究－ 以某區域級教學醫院為例

Applying Theory of Constraints in Inventory Management of Medical Materials－ An Example of A Regional Teaching Hospital

吳良玉(Yu-Liang Wu)

指導教授 ： 林賜德

中原大學/商學院/企業管理研究所/碩士(2012年)

https://doi.org/10.6840/cycu201200123

摘要

現行醫療市場日益競爭，健保局控制醫療成本，因應策略不斷推陳出新，醫
院經營者必須保持高度敏感與應變能力，且需以企業的觀點來經營，才能得以生
存與發展，因此更要重視財物與醫材的規劃與管理。醫療產業是屬於高技術、高
人力之投入產業，與人力相關的變動成本不易與不宜節省，一般台灣醫院之支出
比例人事費43~54%，藥物、衛材約占20~30%，促使各醫院必須想辦法開源節流，
提高醫院本身競爭力，以求永續經營，所以以往一直不被重視的資材成本問題，
自然成為節流策略的首要目標。
應用限制理論( Theory of Constraints；TOC )之重要思考步驟及五個邏輯工具
樹圖探討個案醫院醫材管理，透過現況樹尋找關鍵問題，利用衝突圖暸解、檢視
對策的目的，未來樹確認負面分支的存在，據以修正對策，條件樹列出需實踐新
方案及可能遭遇的障礙與中間目標，再用移轉樹來轉化系統設計所必須之要素，
擬定行動方案與執行準則，在改善過程檢視相關作業流程、系統程式、政策、技
術與人員限制瓶頸等現況問題，抽絲剝繭探究原因進行檢討，進而將限制一一改
善，也必須在合理與品質考量兼顧成本管控下，降低個案醫院之庫存成本，依據
庫存金額、銷貨金額、存貨周轉率、缺貨率、廠商交期等資料分析，應用資訊平
台進行動態監控醫材耗用與提供供應商即時訊息，提供個案醫院建立最適存貨之
循環改善，來符合內、外部環境的要求，使組織系統得到更顯著的整體改善效益。
經由部份方案實施後，資材庫庫備品庫存金額與存貨周轉率，在2010年7
月~12月及2011年資材庫平均庫存金額為1,645,752 ~1,746,684元，平均存貨周
轉率為1.8~2.04次/月，相較於2007年至2010年1月~6月平均庫存金額
1,924,489~2,521,167元，平均存貨周轉率為1.13~1.58次/月，有顯著成效，缺貨
率也從2.5%降至約1.16%，對個案醫院來說，視為一個最適的存貨管理，最適存
貨之庫存金額與存貨周轉率會依照企業所經營的策略與目標去設定，每年企業所
制定的年度方針不盡相同，因發展的方向不同或發展的方向擴大，隨時微調內部
的需求，唯能做好最適之存貨管理，這樣才能讓企業永續經營。

關鍵字

動態監控 ； 存貨管理 ； 庫存成本 ； 醫材 ； 限制理論

並列摘要

The current health care market has been increasingly competitive. Bureau of National Health Insurance continues to introduce new coping strategies for controlling the medical costs.The medical hospital operator must maintains a high degree of sensitivity and adaptability. They should be responsible for the health care in the medical institutions, on the other hand ,they also needs to run their business from an enterprise point of view to survive and develop in the market.Therefore, they should pay more attention to the planning and management of property and medical material. Medical industry is an high-tech and labor intensiv investment, besides, the human-related variable cost is not easily saved and shouldn’t be cutting down. Generally speaking, the percentage of expenditure in the hospital of Taiwan can be divided into staff which costs from 43 to 54% and drugs & medical material which costs from 20 to 30%. It drivens the hospital find the way to control cost and improve the competitiveness to achieve the sustainable management.Thus, the cost of medical material which has been ignored for a long time, now becomes the vital target of strategies for controlling costs.
To adopt the important thinking steps and five logical tool of tree graph in Theory of Constraints(TOC) explore the hospital inventory management, the key problems can be found through the current reality tree, the objects of strategies can be realized and examined through conflict resolution diagram, the existence of negative branch of the future reality tree can be confirmed through which to be modified. The new projects followed and potential obstacles and intermediate objectives would be listed under the pre-requisite tree, then transferred the elements need by system design through the transition trees. By setting up the action programs and implementation of guidelines, the related processes, system programming, policy, technology and the obstacles of personnel limitation can be viewed in the improving process. All the problems caused by constraints can be eventually resolved. Meanwhile, Theory of Constraint means not only to meet both of quality and cost control,but also to reduce inventory costs of the case hospital. Based on the amount of inventory, sales rates, inventory turnover, shortage rate, delivery date of companies and other data analysis, the consumption of medical material and the instant message to supplier can be dynamicly monitored. It can assist the hospital to set up a optimal circulation to achieve the best inventory management and meet internal and external requirements which helps the organizational system improved in the overall efficiency.
Through implementing partial methods of the program derived from TOC, the figure of average medical supply (material) inventory has been reduced to ranged form TWD 1,645,752 to TWD 17,446,684 during July 2010 to Dec 2011, compared to TWD 1,924,489 to TWD 1,746,684 of that during Jan to June 2010. The monthly average inventory turnover ratio has also been improved to from in between 1.8 and 2.04 to 1.13 and 1.58 and the average shortage rate was lowered to1.16% from 2.5% during the same period of time. For the subject (hospital) studied for TOC program application, the establishment of an optimal inventory control system would require it to be dynamically adaptive to its strategic goal and yearly plans. To develop an optimal inventory management strategy is the key factor that leads to sustainable business operation.

並列關鍵字

inventory management ； inventory costs ； dynamic monitoring ； theory of constraints ； medical material

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