某醫學中心全面檢驗自動化合作OT案例研究

Abstract

本研究是以某醫學中心之OT案為例進行研究分析。檢驗部門為了降低成本、增加生產力，籌備建置全面自動化檢驗室。由於新建計劃，公家機構預算必須提早編列，為了提高建置時效性，該醫學中心乃根據促參法（OT案），由民間資金投入建置，合作完成軟硬體建設後及共同營運。 本專案始於2006年，而於2009年終止；歷經三年的建置期，因為資金未能完全到位，無法繼續合作而致解約。 本研究係針對此一合作專案以六標準差DMAIC之方法，並採用焦點團體及質性分析探討此合作案未能成功的因素。分析結果發現失敗原因包括下列幾點： 一、 建置期前 1. 時程、流程與步驟未明確化。 2. 未明訂履約保證，缺乏執行力。 3. 規劃與整合能力不佳。 4. 缺乏風險管理與退場機制。 二、 建置期 1. 執行力與整合能力不佳。 2. 進度延宕，時程模糊。 3. 缺乏溝通。 三、 廠商的財務、資本額，未能因應經境環境的風險。 由本研究之結果，作者建議專案執行團隊成功要素： 1. 成立有效團隊為必要條件。 2. 建立完善履約管理制度。 3. 要有完善績效評估制度，必須包括： 1） 團隊經營實績與專業能力。 2） 空間設置與報價合理化。 3） 經營管理計畫。 4） 商業條件與創意。 4. 根據精實六標準差理論，以DMAIC之分析方法，針對本案例進行實務面的專案分析，發現： 1） 本研究結果可提供公家醫療機構如引用促參法或勞務採購方式時之重要參考。 2） 六標準差可提供一套專案評估機制及釐清問題。 3） 利用六標準差DMAIC可妥善用來分析專案的成功與失敗之關鍵因素。 4） 對組織再造及流程創新提出重要的方向，包括：開發新檢驗資訊系統、空間整修、業務流程、內部績效評核機制、採購與預算，履約管理作為及人才培育等方面；此外本案例研究結果亦提供有相關議題的組織經驗分享與執行方向。

With increasing in number, items and complexity of the laboratory tests and rapid development of new technology and machines, total laboratory automation in the medical setting becomes a trend to integrate machines and operation process in a unified system. Laboratory automation is expected to save manpower, decrease costs and increase productivity. This study aims to evaluate and analyze the causes of failure of an operational transfer project (OT) for laboratory automation conducted in a department of laboratory medicine of a national university based medical center. According to the Law for Promotion on Private Participation in Infrastructure Projects, the aforementioned medical center signed a cooperation contract with a private company. Based on the contract, the partner company was responsible for all the expenses to set up the whole system of automation including both hard and soft wares. The collaborative management for the project was also defined in the contract. The project was implemented from 2006 and terminated in 2009 because of shortage of capitals on the partner company side. The following two methods were used in the present study to analyze the causes of failure for this project: 1) focus group discussion to collect the information from the important participants involved in the project from the beginning and through the whole process: and 2) 6 Sigma DMAIC methodology to examine and evaluate the contents and process of the project running. The results of analysis on this case project revealed the major contributing factors for the failure of this OT project in different stages as follows: 1. At preparation phase:; 1) No clear definition on the time table, process and steps 2) No contract on the punishment for the obvious delay in process and lack of executive ability. 3) Poor quality of planning and integration. 4) Lack of risk-management mechanism and conditions for termination of the project. 2. During working phase: 1) Problems with execution and integration. 2) Delay in processing with unclear time schedule. 3) Lack of communication. 3. Partner’s inability to offer the enough capitals in response to the risks from the global environment. Projected from the study results, the following key points are recommended for the OT public-private partnership project to insure the successful outcome: 1) Establishment of an effective team; 2) Good monitoring management system for the processing by contract; 3) Concrete evaluation methods for: (1) the performance such as professional competence and performance outcome of the team; (2) adequate space design and associated rational quoted price; (3) clear management plan, and (4) business conditions and creativity. In conclusion, the Six Sigma methodology is an adequate tool to provide medical organizations a good guideline for project design and evaluation when they prepare to conduct an OT project. In addition, the present study proposes an important direction for organizations in organization re-engineering and innovation of process, such as development of a new laboratory test information system, redesign of a laboratory space, process of delivery, mechanism of performance evaluation, management of material purchasing and faculty development.