以服務行銷觀點探討公立醫院的醫療服務品質管理

隨著醫學發展，民眾感受醫療的價值提升，醫療市場擴大，機構能藉著提升服務品質得到業績的成長。然而醫療品質管理與行銷策略互相配合，以市場導向為品質改善推動方向並且察覺顧客需要及運用行銷概念，可能是品質改善方案成功的重要條件。服務行銷過去被認為不一定適合於醫療照護產業發展，然而醫療產業對國家產值具有一定貢獻，趨勢變化也使行銷對醫療照護越來越具相關性；在醫療服務水準希望持續進步時，以服務行銷思維提升照護品質便為重要面向，探討服務行銷在醫療品質管理的角色和作法成為有潛在價值的研究方向。本研究標的和範圍是台灣一家公立大學附設醫院的品質管理相關作業活動，在瞭解所有相關的品質管理活動內容後，針對醫院的顧客滿意度調查題項內容進行分析歸類於服務行銷的面向，希望在深入瞭解後能與服務行銷三構面之間找到適當的連結，整理出服務行銷在醫療服務的角色與可能貢獻。我們發現醫院品質管理活動項目內容眾多，整體而言管理活動能夠涵蓋服務行銷在外部行銷，內部行銷以及互動行銷三方面特性。利用評量矩陣進行給分得到積分（滿分240分）後，在三方面總和的分析上，整體涵蓋了服務行銷的內涵最大面向而且可能最具重要性（至少80分）的活動，包括參與政府官方設立的品質測量系統（160分），異常事件通報管理系統（144分），參與醫院品質績效量測系統（128分），進行病人滿意度調查（108分），病人建言處理（104分），病人安全週活動（96分），品質與病人安全課程（96分），衛生局病人安全督導考核活動（88分），衛生局病人安全提案競賽（81分），滿意度調查驅動改善方案（80分）等。針對門診，住院，急診，加護病房以及檢驗醫學部門的滿意度題項內容進行分析後發現個別滿意度問卷內容對於服務品質SERVQUAL特性涵蓋率互有高低，其中以加護病房的滿意度問卷涵蓋的特性最多（77％），門診問卷得的特性涵蓋率最低（45％），就五個滿意度問卷而言，整體SERVQUAL的特性均能包含，而涵蓋題數最多的仍為內部行銷特性的滿意度題項。以加護病房和檢驗醫學部門為例，滿意度問卷特性涵蓋面廣，並且得到醫院品質管理活動支持參與的層面也廣而深，因此在顧客服務品質期望值與感受值的缺口弭平方面具有很大的潛力和成效，我們認為能有此成果是因為在品質改善過程中著重了服務行銷所有三個面向的結果。我們得到以下結論: 一、服務行銷在公立醫院的經營仍扮演重要角色。二、醫療機構品質管理已包含服務行銷多個要素，但仍需進一步強化運用。三、醫療機構服務品質可用服務行銷觀點來衡量，其架構可為品質管理重要指引。四、醫療機構若要運用服務行銷思維升醫療品質，其他產業領域方法可以借鏡。五、醫療機構落實服務行銷確實面臨挑戰，須長時間努力。我們有以下建議：一、服務行銷對醫療機構具正面意義，應該對此領域思維手法積極重視，將服務行銷整體架構納入經營管理和品質改善。二、機構領導階層和主管應積極瞭解服務行銷精神，提升服務行銷能力在未來持續提供優質醫療服務。三、醫療機構員工應瞭解服務行銷重要性，採納顧客需要期望及顧客實際感受的服務品質。四、大眾及病人和家屬應更加認識醫療服務本質以及個人或群體的需要和期望，讓醫療機構瞭解以創造更好的醫療服務環境。

關鍵字

醫療照護；品質管理；服務行銷；服務品質；外部行銷；內部行銷；互動行銷

並列摘要

With the advance of medicine and perceived improvement of the value of medical care, the healthcare market expands, and institutions can achieve growth through improvement of the service quality. As healthcare quality management and marketing strategies might complement each other, institutes might need to enhance market-oriented with perceived customer needs and the use of marketing concepts. Despite the previous controversy, service marketing might be important for health care industry which contributes substantially to the national gross domestic production. Marketing theory applied to the quality of care will be an important aspect of medical quality management and research. This scope of this study was the quality management-related activities of a public hospital in Taiwan. After the understanding, the content of all relevant quality management activities, the contents of the survey on customer satisfaction of the hospital is classified into the service marketing categories. We wished to find the appropriate link between the three dimensions of service marketing and the service marketing, and sort out the role and possible contribution of service marketing in medical service. We found the quality management of the hospital included many activities. Overall these activities covered all aspects of service marketing. We applied a matrix to score each survey (totally 240 points) to find the most relevant activities (at least 80). The most relevant activities included participation in government provided measures (160 points), incident reporting system (144), participate in hospital quality performance measurement system (128), patient satisfaction survey (108), complaint management (104), Patient Safety Week activities (96), quality & safety training course (96), patient safety audit by authorities (88), patient safety proposal contest by authorities (81), and satisfaction survey driven improvement program (80). The content of the satisfaction questionnaire for the outpatient service, inpatient area, the emergency department, the intensive care unit and the laboratory department were analyzed. We found the coverage of service marketing of the individual questionnaire varied, with the highest of ICU (77%), and the lowest of the outpatient questionnaires (45%). The five satisfaction surveys together can include the whole characteristics of SERVQUAL, most for internal marketing. The intensive care units and the laboratory department had the widest coverage of SERVQUAL characteristics, and these two areas also had the most support by the quality management activities. As a result, it is most likely that the gap between the perceived and expected service quality can be minizied. We believe this was because that these service areas emphasized all three dimensions of service marketing. We have the following conclusions: First, service marketing in public hospitals plays an important role. Second, the healthcare quality management has included some elements of service marketing, but still need to strengthen their use further. Third, the quality of healthcare can be measured by the point of view of service marketing, which can serve as a valuable guide. Fourth, the healthcare can learn from other industries to apply service marketing concepts. Fifth, implementation of service marketing remains challenging. We provide the following recommendations: First, service marketing has a positive significance for the health care and should be seriously understood for applying into healthcare management and quality improvement. Second, institutional leadership and executives should actively understand the concepts of service marketing to improve service delivery in the future and provide quality medical services. Third, the medical staff should understand the importance of service marketing, customer expectations and the actual needs of customers to experience the quality of service. Fourth, the public and patients and their families should be more aware of the nature of medical services that individuals or families may express their needs and expectations so that medical institutions to understand to create a better medical service environment.

並列關鍵字

Healthcare ； quality management ； service marketing ； service quality ； external marketing ； internal marketing ； interactive marketing

參考文獻

楊緒棣，2006，醫療行銷: 以新店慈濟醫院為例，臺灣大學商學研究所學位論文: 1-63.

廖筠松與廖彥琦，2004，行銷策略在長期照護的運用，長期照護雜誌，8卷1期：13-23.

黃雯菁與黃庭鍾，2009，內部行銷對組織承諾影響之研究-以北部某醫療機構護理人員為例，安泰醫護雜誌，15卷4期：211-224.

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以服務行銷觀點探討公立醫院的醫療服務品質管理

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