醫院品質管理創新與醫院績效關係之縱貫性研究─以醫療品質獎為例

A Longitudinal Study of the Relationship between Managerial Innovation and Performance in Hospital-- The Case of Healthcare Quality Improvement Campaign

吳佳潔(Chia-Chieh Wu)

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.2010.00795

摘要

財團法人醫院評鑑暨醫療品質策進會所舉辦之醫療品質獎自2000年開辦至今已達10年，不過相關實證研究仍然缺乏。究竟參加醫療品質獎對醫院營運績效的效果為何？這是本研究欲瞭解的部分。因此，本研究目的有三：（一）瞭解影響國內醫院選擇參加醫療品質獎的組織與市場因素；（二）驗證有無參加醫療品質獎與醫院近期營運績效之關係；（三）進一步透過長期資料，探討參賽醫院對醫療品質獎之投入與績效間的關係。
本研究整合醫策會醫療品質獎參賽紀錄與衛生署醫事機構統計資料，首先以橫斷面分析國內392家醫院於醫療品質獎第1-9屆期間參與之情形，其中有120家醫院曾參與活動；研究架構二則針對117家參賽醫院，以廣義估計方程式（GEE）探討醫院參賽投入與績效之關係。
研究結果如下：
(一)醫院組織與市場特質確實影響醫院選擇參加醫療品質獎
在醫院特質方面，公立醫院、區域層級及病床規模大之醫院參加品管圈競賽活動機率高；在醫院過去績效上，高門診市佔率與高住院市佔率醫院傾向參加活動；在市場環境方面，處於高度競爭市場之醫院，其參加醫療品質獎的機率較高。
(二)有參加醫療品質獎醫院在近四年（2005-2008）平均病床週轉率、門診市佔率及住院市佔率較佳
(三)醫院參賽特性與獲獎分數與住院市佔率有顯著關係
在競賽獲獎成績方面，進階組醫院表現較佳、報名圈數與競賽表現呈正相關、改善主題類型涵蓋數則與獲獎成績呈負相關；至於在住院市佔率方面，醫院在醫療品質獎之參賽特性中，僅進階組醫院與其呈負向影響。
根據以上結果，本研究建議：（一）推動醫療品質提升活動之主辦單位應鼓勵與輔導地區層級以下的醫療院所前來參與，並加強宣導醫療品質獎活動的核心價值─學習與成長；（二）已參賽醫療機構管理者應將所學拓展至全院政策落實以持續改善品質，而處於觀望階段的醫院應主動報名為佳；（三）後續研究者應多面向觀察醫院參與醫療品質獎行為，並利用多層次分析概念衡量醫院參與活動與績效間之關係，最後建議可引用組織學習理論或策略觀點切入主題。

關鍵字

管理創新 ； 品管圈 ； 醫療品質獎 ； 縱貫性研究

並列摘要

Since 2000, Healthcare Quality Improvement Campaign (HQIC) has been implemented by Taiwan Joint Commission on Hospital Accreditation (TJCHA) for 10 years; however, there is still a lack of empirical studies. What are the effects on operating performance of the hospitals attending contest of HQIC? There are three aims for this study: (1) to identify the organizational and market factors that may explain the joining of HQIC for hospitals in Taiwan, (2) to examine the impact of hospitals attending contest of HQIC on current operating performance, and (3) to explore the relationship between hospitals attending contest of HQIC and the performances by way of panel data.
This study integrates the records of HQIC from TJCHA and Annual National Hospital Services Survey from Department for Health (DOH). Firstly, cross-sectional design is used to analyze the variations of 392 hospitals in Taiwan that included 120 attending hospitals from the first to ninth HQIC. Furthermore, focusing on 117 attending hospitals, the relationship between the participation efforts and performances is explored via Generalized Estimating Equation (GEE).
Our findings are as follows:
1.The organizational and market characteristics do affect the choice of attending HQIC
Based on hospital features, the probability of attending HQIC is higher for public, regional and large-sized hospitals. According to past performance of hospitals, high market share (for both outpatients and inpatients) hospital are inclined to enroll in the contests. For market characteristics, hospitals situated in higher market competition have higher probability of attending HQIC.
2.Hospitals attending HQIC have positive associations with bed turnover rate and market share for outpatients and inpatients from 2005 to 2008.
3.Characteristics of attending hospitals are significantly related with HQIC scores and market share for inpatients
Hospitals attending advanced groups performed best in contest awards, but they had a negative effect on market share of inpatients. The number of Quality Circle teams is positively correlated with contest performance and the coverage of improvement themes is negatively correlated with HQIC scores.
According to the findings above, it is recommended that (1) the host organization promoting healthcare quality enhancement programs should encourage and facilitate the enrollment of hospitals that are inferior to district hospital and reinforce promoting the core value of HQIC –“learning and improving”; (2) while quality circle teams of the attending hospitals should expand learned knowledge and implement it into hospital-wide policy to continue quality improvement, the non-attending hospitals should actively participate the activities; (3) future researchers should observe hospitals’ behaviors of attending contest of HQIC in multiple dimensions, multi-level analysis could be utilized to examine the relationship between the enrollment and performance, and, finally, researchers may dig into the main issue of this research through utilizing the theory of organizational learning or strategic perspective.

並列關鍵字

Managerial Innovation ； Quality Circle ； Healthcare Quality Improvement Campaign ； Longitudinal Study

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