運用平衡計分卡改善某醫院附設護理之家營運績效之初探

The Preliminary Study of Applying Balanced Scorecard Model in Evaluating Hospital Nursing Home

林富美(Fu-Mei Lin)

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(2005年)

摘要

我國人口結構迅速老化，家庭結構及疾病型態改變，對醫療照護的需求由急性醫療逐漸轉為對長期照護的依賴。在長期照護機構競爭劇烈的環境下，提供兼顧照護品質、經營成本及住民與家屬滿意的照顧環境，是從事長期照護者應努力的方向。平衡計分卡是一個化策略為行動的策略績效管理工具，兼具顧客、財務、內部流程及員工學習與成長構面，能有效運用策略以達成組織願景。 本研究的目的在建構促使護理之家的策略目標及績效指標，進而建立一套策略管理系統，改善護理之家的營運績效。本研究採介入性研究設計，在護理之家營運策略中，導入平衡計分卡，建構績效指標，比較實施平衡計分卡前後各項績效指標之差異。收案採立意取樣，取自台北某醫院附設護理之家之工作人員、住民及其家屬。研究工具包括員工工作滿意度量表及護理之家服務滿意度量表、損益月報試算表、品質監測統計表、業務月報表及技術稽核統計表，資料收集期間由2004年1月至10月。員工工作滿意度量表及護理之家服務滿意度量表前測收案時間為同年2月，後測時間為同年8月，員工問卷共發出60份，回收54份，回收率90%，有效問卷為42份，有效問卷率為77.8%。住民家屬問卷共發出94份，回收94份，回收率100%，扣除住民往生及非同一家屬回答之有效問卷為72份，有效問卷率為76.6%。 本研究於2004年3月至7月期間實施護理之家平衡計分卡策略方案，在顧客構面新增多元化活動、急診就診持續服務及每日醫師巡房制度；在財務構面改採集中區域照護及加強院內外行銷；在內部流程構面執行長期照護指標品質監測及改善措施、制定院內感染控制標準規範、以品管圈活動改善衛材管理；在員工學習與成長構面進行員工教育訓練，制定各項護理技術標準規範及加強護理照護技巧演練。資料以描述性統計分析、pair-t檢定、independent-t檢定及無母數Wilcoxon檢定實施前後各項績效指標之差異。 本研究結果顯示如下，(一)在顧客構面：住民家屬對護理之家之服務滿意度得分實施後比實施前高，由113.22(SD=13.73)提升至120.19(SD=17.84)，標準化分數為69%提昇至73.3%，達統計上顯著差異(p< .05)；(二)在財務構面：每床每月成本實施後比實施前降低。(三)在內部流程構面：1.住民感染率、壓瘡點盛行率及非計畫性轉住急性病房比率實施後比實施前升高，主要原因為工作人員離職集中在5、6月，人力無法及時補足導致；2.衛材漏帳率實施後比實施前降低。(四)在學習與成長構面：1.員工工作滿意度實施後比實施前高，由84.19(SD=5.51)提升至89.38 (SD=6.93)，標準化分數為72.5%提昇至77%，達統計上顯著差異(p< .05)；以「與住民及家屬相處和諧融洽」得分最高，以「目前工作量的負荷程度」得分最低。2.員工離職率2004年比2003年降低，由57.1%降至32.1%。3.員工照護技能正確率實施後比實施前高，達統計上顯著差異(p< .05)。 由本研究可以了解護理之家實施平衡分卡，雖然遭遇人力短缺，導致內部流程構面品質監測指標值下降，但其他構面之各項績效指標均有提升，期望本研究能提供醫院型態護理之家做參考，也能推廣至其他型態護理之家、長期照護機構或醫療機構營運之參考。 關鍵詞：平衡計分卡(Balanced Scorecard)、護理之家(Nursing Home)

關鍵字

平衡計分卡 ； 護理之家

並列摘要

As the population is aging rapidly, and the family structure and disease patterns are changing, the healthcare need has been shifted from acute care to long-term care in Taiwan. Hence, in the highly competitive environment of nursing homes, quality, cost-effectiveness, and customer satisfaction should be the goals that long-term care institutions strive for. Balanced scorecard is a strategic management tool to transform strategies into practice, which focuses on customer perspective, financial perspective, internal process perspective, and employee’s learning and growth perspective, to effectively implement strategies so as to meet organization’s missions. The purposes of this study are to establish strategic objectives and performance indicators to facilitate nursing home’s successful operation to improve the performance of nursing home. The study was designed to be an interventional study, after applying balanced scorecard to nursing home operation strategy, to compare the differences of performance before and after implementing balanced scorecard. The study sample is selected by convenient sampling. The study subjects were selected from some hospital nursing home in Taipei, consisting of employees, residents and their relatives. Data collection was done from January to October in 2004. Balanced scorecard strategy was implemented in the nursing home for this study from March to July in 2004. We used descriptive statistics, pair-t test, independent-t test, and nonparametric Wilcoxon test for data analysis to compare the differences of each performance indicator after implementing balanced scorecard. The results of this study are as the following: 1.Customer perspectives: the satisfaction score of residents’ relatives for the nursing home had improved after implementing balanced scorecard, and the difference is statistically significant (p< .05). 2.Financial perspectives: the cost per bed per month was decreased after implementing balanced scorecard. 3.Internal process perspective: (1)Nosocomial infection rate, pressure sore point prevalence, and the rate of unexpected transfersdischarges to acute inpatient care increased after implementing balanced scorecard causing lack of man power in that period. (2)The missed billing of medical supplies rate decreased after implementing balanced scorecard. 4.Learning and growth perspective: (1)Employees’ satisfaction had improved after implementing balanced scorecard, and the difference is statistically significant (p< .05). The highest score is on “harmonious interaction with residents and their relatives” whereas the lowest score is on “current workload”. (2)The personnel turnover rate decreased from 57.1% in 2004 to 32.1% in 2003. (3)The nursing care techniques accuracy improved after implementing balanced scorecard, and the difference is statistically significant (p< .05). The research results indicate that implementing balanced scorecard in nursing home will lead to performance improvement although some quality indicators slack off due to the unexpected shortage of manpower in this study. Hopefully, this study would be helpful for not only hospital nursing homes, but also other types of nursing home, long-term care institutions and healthcare organizations. Key words : Balanced Scorecard, Nursing Home.

並列關鍵字

Balanced Scorecard ； Nursing Home

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