背景:平衡計分卡是一個在商業界已經導入十餘年的策略管理與績效管理工具,目前在醫療產業也是蔚為一股推行的風潮,但是在長期照護產業仍然是一個尚未被廣泛使用的工具。它利用四個不同的構面:學習與成長構面、流程構面、顧客構面與財務構面,能夠有效的結合機構原有的經營理念與願景作為一個全方位的考量,並且能夠有效的評量機構的過去、現在與未來的競爭能力。因此獨立型態護理之家如何運用平衡計分卡以維持其競爭優勢,以便在眾多的競爭者中維持市場佔有率及營運績效,是經營者極需重視的課題。 目的:1. 建立一套適用於獨立型態護理之家的平衡計分卡績效指標及具體行動方案。2.比較實施平衡計分卡前後,獨立型態護理之家各構面績效的差異。 方法:本研究屬橫斷式前後比較方式(One group pretest posttest design)法,經彰化縣某158床獨立型態護理之家同意為研究母群體,收案對象為護理之家之工作人員、住民及其家屬。在2010年11月至2011年4月之間,按照規劃的平衡計分卡營運管理指標收集各構面資料及發放員工滿意度問卷(有效問卷共30份)、住民家屬滿意度問卷(有效問卷共42份)。 結果:一、實施平衡計分卡後,在學習與成長構面上,員工技術稽核成績包括會陰沖洗、翻身扣背、抽痰及氣切護理,員工記錄完整性包括護理人員及照顧服務員成效皆比實施前為佳(p<0.05)。二、實施平衡計分卡後,在流程構面上,非計畫性轉至急性醫院住院比率成效比實施前為佳(p<0.05)。三、實施平衡計分卡後,在顧客構面上,員工滿意度及住民家屬滿意度成效皆比實施前為佳(p<0.001)。四、實施平衡計分卡後,在財務構面上,應收未收帳款比率成效比實施前為佳(p<0.01)。 結論:本研究所提出之財務目標-減少呆帳,確實能夠藉由本研究所建構之獨立型態護理之家平衡計分卡達成,其中的策略地圖在學習與成長方面依序為建構標準作業、落實在職教育、定期技術稽核、確實實行照護作業等,在流程構面則為提升照護品質,在顧客構面則為提升員工滿意度及顧客滿意度,最後在財務構面則為減少呆帳。
Background: Balanced Scorecard as a strategy management tool, has been intensively used in commercial industry for past decade, nevertheless, it is just introduced in long term care industry. Balanced scorecard encompasses four different dimensions, which are financial, customer, internal business processes, and learning and growth. It provides a strategic map meet the vision, values and mission of an organization. Through the operation of balanced scorecard, the institution can exam its key performance indicators to pursuit competitiveness. Therefore, to apply Balanced Scorecard to keep their competitive advantage, market share, and improving performance among competitors is a crucial issue for the management team. Object: 1. To develop a balanced scorecard’s performance indicators and subsequent action plans for an independent nursing home. 2. To compare the deference on each dimension’s performance in independent nursing home before and after the implementation of balanced scored card. Method: The research design adopted one group pretest and posttest mode and enrolled the staff, residents and their families as target interviewees in the independent nursing home of 158 beds in ChangHua County. Between in November 2010 to April 2011, all key performance indicators distributed at 4 levels of balanced scorecard and subsequent data, as well as satisfaction survey of 30 employees and 42 residents’ families were collected. Results: 1.After implementing balanced scorecard, staff technical reviews including perinea wash, turn buckle back, suction, tracheotomy care, and completeness of daily report, including nurse and caregiver, in learning and growth dimension are better than before(P<0.05). 2.After implementing balanced scorecard, unexpected hospitalization rate in internal business process dimension are better than before (P<0.05). 3. After implementing balanced scorecard, satisfaction survey of employees and residents’ families in customer dimension are better than before (P<0.001). 4. After implementing balanced scorecard, accounts receivable ratio in financial dimension is better than before (P<0.01). Conclusion: The financial goal proposed by the research, which is bad debt reduction, can be achieved via the balanced scorecard implementation for the independent nursing home sampled in the research. Its strategy maps are able to build up standard operational procedures, implement on-job education, regular technical reviews, implement care operation etc in learning and growth dimension, promote care quality in internal business process dimension, improve employee and customer satisfaction in customer dimension, and reduce bad debts in financial dimension.
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