醫院全面品質管理／持續性品質改善推行模式、策略類型與組織績效間之相關性研究

A Study of Relationship among Implementation Model of Total Quality Management／Continuous Quality Improvement,Strategic Types and Hospital Performance

李宛靜(Wan-Ching Lee)

指導教授 ： 鍾國彪

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.10281

摘要

研究目的：瞭解醫院採取策略類型，與院內全面品質管理/持續性品質改善推行模式概況，與組織績效間關係。

研究方法：本研究採用問卷調查研究與次級資料分析，先進行郵寄問卷資料蒐集，接續將回覆問卷樣本醫院與88年至97年之衛生署醫療機構現況及醫院醫療服務量資料庫併檔分析。以各院院長、副院長及單位主管為調查對象，研究期間為2009年9月1日至10月13日，回收有效問卷388份，總回收率為26.06%，共計91家醫院回覆，家數回收率為65.71%。

研究結果：策略類型以反應者74家為最多（81.32％），其次為防禦者11家（12.09％）及探勘/分析者6家（6.59％），採取防禦者醫院相對其他類型，於早期門診人次、晚期門診人次、早期出院人次及晚期出院人次績效表現較好。探討全面品質管理/持續性品質改善推行模式三項要素，發現「品質結構」會提升晚期門診人次、早期出院人次及晚期出院人次績效，早期佔床率績效指標受到「領導者承諾與資源投入」影響，「品質測量與團隊」會影響晚期佔床率與晚期病床週轉率績效。建議醫院未來以分析者類型為發展方向，創造並提供符合病患為中心之服務品質，並持續致力於全面品質管理/持續性品質改善推行，包含院長對品質持續性承諾、對醫護人員進行長期教育訓練，與確保有品質認知及對技術的純熟度等關鍵力量。

關鍵字

策略類型 ； 全面品質管理推行模式 ； 經營績效

並列摘要

Purpose
The purpose of this study was to find out the adaption of strategic types and total quality management implementation state in hospitals and the relationships between organization performance.

Methods
Data collections were applied by questionnaire investigation and secondary data analysis. Combined the replied hospitals’ data with the statistical annual report of medical care institution's status and hospital's utilization database from 1999 to 2008. The participants were superintendents, deputy superintendents and chiefs. There were 388 persons valid samples (91 hospitals replied)and yielding a response rate of 26.06％ (65.71%)with collection period from September 1 to October 13, year 2009.

Results and recommendations
The majority strategic types was reactors(74 hospitals, 81.32％), the second was defenders(11 hospitals, 12.09％)and the least was prospectors／analyzers.(6 hospitals, 6.59％) Compared with others strategic types, reactors has higher performance in early phase of outpatient visits, later outpatient visits phase, early phase of discharge and later discharge phase.
Discussed with three factors of total quality management implementation, we found that “quality structure” increased later outpatient visits phase, early phase of discharge and later discharge phase, “leadership promises and resource input ” affected early phase of occupancy rate and “quality assessment” impacted on later occupancy rate phase and later turnover of beds rate phase.
We suggest that hospitals should target analyzers to provide the service quality that conform with patients, sustain to be devoted to implement total quality management which includes the persistence of leadership promises, long-term training for physicians and nurses, well-known for quality cognition and well-versed technique.

並列關鍵字

strategic types ； total quality management implementation ； organization performance

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