運用平衡計分卡提升護理之家營運成效之探討

Using Balanced Score Card to Promote Performance at a Nursing Home

黃慈心(Tzu-Hsin Huang)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

台灣人口組成面臨劇烈轉變，65歲以上人口比例，至西元2003年3月達8.87%，並預估在2036年時增加為21.7%(內政部，2000年)。隨著老人人口增加，疾病型態慢性化、家庭結構的改變以及婦女就業增加，導致國人對長期照護需求日益殷切。 根據中華民國長期照護專業協會資料顯示，從1995年底全國有9家護理之家，截至2002年8月底全國共有222家護理之家(11,181床)，總成長率達23倍。由此可見現階段的市場是供過於求，因此機構經營面臨的主要問題是市場競爭；如何在產業環境中具競爭力，已是重要課題。 本研究目的在建構一套完整的平衡計分卡於護理之家及比較實施前後營運成效之差異。研究設計為介入措施同組前後測研究，採立意採樣，收案對象為護理之家工作人員、住民及其家屬。研究工具有結構性問卷包括工作人員滿意度量表和住民家屬滿意度量表及損益報表、照護品質管理報表、住民動態管理報表。收案時間為2002年10-12月起及2003年5月15日：護理人員共28人、住民家屬共28人參與及住民(實施前2670人次、實施後3480人次)。 於2003年1月15日起對護理之家實施平衡計分卡行動方案，在學習成長面：強化員工長期照護知能與技能；在內部流程面：制定流程與標準、舉辦醫護聯合討論會；在顧客面：提供多元特色的治療活動、設立抱怨專線專人處理；在財務面：教育員工成本概念及節流措施；同時進行實施前後營運成效之比較。資料以描述性統計分析、pair-t檢定、independent-t檢定實施前後得分之差異。 根據研究結果獲得以下結論：(一)運用平衡計分卡後員工學習成長面成效比運用前為佳：(1)護理人員照護評估計劃認知於實施後較實施前為佳，且達統計上顯著差異；(2)護理人員在照護記錄完整性於實施後較實施前為佳，且達統計上顯著差異；(3)病患服務員在生活照護評估認知於實施後較實施前為佳，且達統計上顯著差異；(4)病患服務員在照護記錄完整性於實施後較實施前為佳，且達統計上顯著差異；(5)員工工作滿意度：實施後滿意度較實施前為高，但未達統計上之顯著差異。(二)運用平衡計分卡後內部流程構面成效比運用前為佳：(1)轉住急性醫院照護件數，實施後較實施前為低，且達統計上之顯著差異；(2)跌倒發生件數實施後較實施前為低，且達統計上之顯著差異；(3)院內感染率，實施後較實施前為低，且達統計上之顯著差異。(三)運用平衡計分卡後顧客構面成效比運用前為佳：(1)佔床率實施後較實施前為高，且達統計上之顯著差異；(2)長期住民佔有率實施後較實施前為高，且達統計上之顯著差異；(3)住民抱怨件數實施後較實施前為低，達統計上之邊緣性差異；(4)住民家屬滿意度在硬體建設、日常生活照護、照護服務等，實施後較實施前為高，且達統計上之顯著差異。(四)運用平衡計分卡後財務構面成效比運用前為佳：(1)每床日營運成本實施後較實施前為低，且達統計上之顯著差異；(2)營收成長率在實施後月平均為+9.93%，實施後較實施前為高，且達統計上之顯著差異。 運用平衡計分卡於護理之家對四個構面的的績效有顯著差異；希望藉由本研究可帶動機構式護理之家在提昇照護人員專業技能及工作滿意度、顧客的開發與延續、品質管理及財務面的開創之研究參考。

關鍵字

平衡計分卡 ； 護理之家

並列摘要

The age distribution in Taiwan has changed drastically in recent years. The number of people over 65 years has reached 8.87% out of entire population in March of 2002. This percentage is expected to increase to 21.7% in the year of 2036 (data from Internal Affairs, Taiwan 2000). With the increase in elderly population, more chronic illnesses are observed. There are also changes in family configurations in which more females have joined the work force. As a result, nursing home care has become an important chronic care system for the elderly population in Taiwan. Based on the data provided by the Taiwan Long-Term Care Professional Association, there were only 9 Nursing Homes and Chronic Care Centers at the end of 1995. But, until August 2002 the total of Nursing Homes and Chronic Care Centers reached to 222 (11,181 beds), almost 23 % increasing. Thus, the supply of nursing home beds far exceeds the needs. Therefore, how to set up an effective evaluation system has become most important issue to be able to manage a nursing home center competitively. While the Balanced Score Card will assist institutions to enforce their strategies into more practical actions, to achieve their goals more effectively, and to realize institutional visions. The purpose of this study is to build up a complete Balanced Score Card system, and to evaluate the different in management efficiency before and after implementation of this system. This is a intervention reasoning study, with samples gathered in a Nursing Home situated in Tao Yuan county. The recruited subjects were employees of the Nursing Home and family members of the in-patients. This study was questionnaire based, started from October 2002 and ended on May 15th, 2003. There were 28 nurses and 28 family members participated in this study. The Balanced Score Card consists a very comprehensive evaluation and managing system, which includes four aspects: 1.Learning and growth, 2. Internal business process, 3. Customer services, 4. financial condition. The following results were obtained: 1.The recruited subjects revealed improvement in learning and growth aspect after using the Balanced Score Card. (1)Nurses were observed to have significant improvement statistically in patient caring plan after using the Balanced Score Card. (2)Nurses were observed to have significant improvement statistically in caring records after using the Balanced Score Card. (3)Nurse’s Assistant members had better caring knowledge of patients’ daily activities after using the Balanced Score Card; and were statistically significant. (4)The job satisfaction of employees was increased after the implementation of Balanced Score Card. However, no statistically significance was noted after analysis. 2.Better internal business process result was observed in the Nursing Home after the implementation of the Balanced Score Card: (1)Patient transfer to acute hospital was fewer. (2)Cases of fall decreased. (3)The percentage of nosocomial infection improved. 3.In terms of customer services, improved customer satisfaction was observed after using the Balanced Score Card; and were statistically significant proved: (1)Higher bed occupancy rate was noted. (2)Percentage of long term nursing home patient care increased. (3)Fewer complaints were noted from the patients and caregivers. (4)Higher family member satisfaction was noted. This included higher satisfaction in nursing home hardware, care of daily activities, and nursing care. 4.Improved financial condition was noted after implementing the Balanced Score Card system, and was statistically significant proved: (1)The average bed cost per day was proved to be lower. (2)Higher percentage of financial gain was noted. As observed above, the Balanced Score Card System is beneficial to the nursing home in many aspects. Therefore, we hope this study can be an essential reference and guidance in managing the nursing care centers.

並列關鍵字

Balanced Score Card(BSC) ； Nursing Home

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