探討醫院推行品管圈的發展趨勢─以醫療品質獎為例

To Explore the Development of Quality Control Circle in the Hospital ─An example of Healthcare Quality Improvement Campaign

何宛青(Wang-ching Ho)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

1995年開辦全民健保以來，品管圈活動被醫療界廣泛引用及推動，成為重要的品質改善活動之一，國內醫療品質推動的專屬機構─財團法人醫院評鑑暨醫療品質策進會(以下簡稱醫策會)，於2000年開始推動品管圈的改善成果競賽發表，取名為醫品圈(Health Quality Improvement Circle，HQIC)，獲得國內各醫療院所的熱烈參與。
本研究主旨在探討醫院推行品管圈的發展趨勢─以醫療品質獎為例，為一縱斷面之調查，研究方法分為文件分析及深度訪談10位評審、13位參賽者、1位主辦單位。研究結果發現歷屆HQIC的機構數有逐年增加，從第一屆42家(79圈)至第九屆61家(131圈)；申請部門以護理部門占多數，從第三屆開始跨單位日益增多，逐漸看到有醫師參與(5圈)，並開始講究團隊合作；選定主題從原本單位內問題，演變為因應總額預算、醫院評鑑、病人安全等主題。參與主題以病人照護為主要依據；從最初的「服務品質」發展成近年重視的「病人安全的品質」。整體而言，品管圈從原本的點(單位內)至線(單位間)更擴展至面(全院性活動)，讓醫院的需求化作品管圈的主題，讓現今的品管圈逐漸演變成一種由上而下的改善方式。
研究結論：醫療衛生機構所做的品質提升工作從問題導向演變至目標導向，而針對目標採取的策略管理，加上院長支持、醫師參與、制度面的建立、品質管理專責單位的成立，顯示其「醫療品質管理」是大家眾所矚目的焦點。
HQIC的經驗，可以給予醫院做品質改善的引導及推動，包括文化的建立，也就是仰賴全員參與，提升對於品質的認知、態度及意識，並融入日常生活管理，納入標準作業中，進而內化成醫院的品質文化；藉由發表、標竿學習、建立獎勵制度等方法輔助，達成提升醫療品質之目的。

關鍵字

品管圈 ； 深度訪談 ； 醫療品質獎

並列摘要

Since the National Health Insurance was implemented in 1995, Quality Control Circle (QCC) has been one of the important quality improvement activities for most domestic medical institute. The exclusive institute to improve healthcare quality is named Taiwan Joint Commission on Hospital Accreditation. The improvement achievement Campaign of QCC beginning from 2000 and is named Healthcare Quality Improvement Campaign (HQIC).
The purpose of this research is to explore the development of Healthcare Quality Improvement Campaign (HQIC) by Taiwan Joint Commission on Hospital Accreditation. This research is a cross section study. The research method divides into the document analysis and the depth interview for 10 experts, 13 participants and 1 organizer.
In the findings, the institutions of participate in HQIC have increased every year. It has 42 institutions (79groups) in 1st HQIC, and now expends 61 institutions (131groups) in 9th HQIC. The participants departments are mainly nurse. It has to increase cross-departments since the 3rd HQIC (5groups). It mainly sees to join with the doctor and start focus on team-work. In the selecting topics, the problems in the department evolve the topics about selecting changes of environment, such as global budget, hospital accreditation system, patient safety. The topics are mainly about patient care. In the beginning the quality of service develop attention-getting the quality of patient safety. Broadly speaking, quality control circle is a little drop, changes the filament but now expand the entire area. That makes the hospitals’ need transform the tops of quality control circle. Now quality control circle gradually evolves an improvement way from top to bottom.

In Conclusion, the topics about the quality improvement activities that the hospitals do make from problem-oriented to object- oriented. It makes quality control circle not only solve the problem but also achieve the object to promote medical quality. In view of the goal, strategy management, superintendent’s support, the participation of doctor, the establishment of rules, and the establishment of department of quality management show that everyone is focus on medical quality.
HQIC can give hospital guidance doing quality improvement activities, include the establishment of culture, and the participation of everyone to promote the cognition, attitude, sense, and integrate into the daily management, fit into standard operation procedure to cultivate quality culture. It achieves the goal to promote medical quality by publishing, benchmarking, and establishing reward rules.

並列關鍵字

Quality control circle ； depth interview ； Healthcare Quality Improvement Campaign

參考文獻

廖素玲(2007)，醫院推行品管圈之醫療品質影響成效研究─以財團法人醫院評

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