醫院採行品質管理活動與醫院績效關係之縱貫性研究

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 我國自民國八十四年實施全民健康保險之後，醫療生態即產生巨大的轉變，各醫療機構唯有靠良好的品質與服務方能吸引顧客 ( 病患 ) 。因此，國內各醫療機構在全民健保開辦之前後數年，紛紛開始推展各類之品質管理相關活動 ( 如：全面品質管理、品管圈、臨床路徑、 ISO 認證、提案制度、

流程再造、 5S 運動、實證醫學、學習型組織、六個標準差與醫療品質指標計畫等 ) 。然而國內尚無探討有關醫院各品質管活動與經營績效之實證研究，因此本研究希望能透過長期觀察，來探討醫院品管活動與經營績效之關係。

　　本研究為一縱貫性的研究，在初級資料的蒐集上，以國內屬地區教學級以上 128 家醫院為研究對象，以問卷方式調查醫院過去十一年內 ( 民國 83 年至民國 93 年 ) 曾推動之品質管理之種類、推動起始時間及推行現況，以及主管對品質管理活動的主觀認知績效，問卷回收率達 54.68% 。另一方面，由行政院衛生署之相關統計資料中取本研究所需的其他相關變項，最後再以 GEE 迴歸模式來分析醫院品質管理活動與績效間的關係。

　　本研究的主要發現如下：

1. 醫療品質指標計畫與臨床路徑為目前醫院最普及採行的品質管理活動。

2. 實證醫學與六個標準差對醫院整體績效有顯著的提升作用。

3. 全面品質管理、流程再造、 5S 運動與實證醫學對醫師生產力有顯著的正向影響。

4. 全面品質管理與實證醫學對醫院佔床率有顯著的正向影響。

5. 品管活動數越多，對醫院績效與醫師生產力都有顯著的提升作用。

6. 對於提升「門診量」、「住院服務量」、「員工工作滿意度」、「病患滿意度」、「行政服務品質」、「醫院整體形象」、「醫院營運」、「平均住院日數控制」與降低「醫療糾紛」等不同績效構面，各種品質管理活動都有其特定效果。

　　本研究結果顯示，品質管理活動能有效地提升醫院的營運績效，而且採用的品管活動愈多，醫院的營運績效也會提升愈多。因此，建議醫院管理者應對品質管理活動訂定中長期計畫，不斷持續地推行。關鍵字：品質管理活動、營運績效、縱貫性研究

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Relationship between Quality Management Activiti es and Hospital Performance in Taiwan--A Longitu

dinal Study

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After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

　　 The study samples include about 128 regional (and above) teaching hospitals in Taiwan. A questionnaire will be sent to each hospital for collecting related information. An interviewer will be sent to those hospitals without providing sufficient inf ormation for collecting supplemental information. All the data collected was linked to the National Hospital Survey conducte d by the Department of Health, the Executive Yuan for analysis. Data collected from the questionnaire including quality mana gement programs promoted in hospitals, beginning time of each program, and some hospital performance indicators over the past decade (1993-2004). The response rate was 54.68%. GEE regression was then applied to analyze the longitudinal impact of quality management activities on hospital performance.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

In conclusion, the results proved that quality management activities have positive effects on hospital performance. In other wo rds, promoting health care quality will lead to better hospital performance. Therefore, we suggest hospital administrators to de sign a long term plan to promote quality management activities continuously.

醫院採行品質管理活動與醫院績效關係之縱貫性研究

After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

Keywords: Quality management activities, Hospital performance,

Longitudinal study

醫院採行品質管理活動與醫院績效關係之縱貫性研 究

After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It&apos;s expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

Keywords: Quality management activities, Hospital performance,

Longitudinal study

醫院採行品質管理活動與醫院績效關係之縱貫性研究

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.