運用模擬技術於門診藥局之流程改善－以某醫學中心為例

Abstract

健保開辦以來，國內醫療環境進入了日趨競爭的狀態。追求服務品質、降低成本，以提升組織運作的效率與效能，成為機構能否永續生存的關鍵。「等候」是影響顧客滿意度重要因素之一，能夠縮短顧客的等候時間，就能夠提升滿意度促進服務的品質。增加資源是解決等後時間最簡單的方法，但是資源是有限且珍貴的。如何將有限的資源花在刀口上成為經營管理者的重要的課題。現今是講求以科學證據做基礎的時代，因此在決定實施新的改善方案前需要更有實證根據的決策評估，此時模擬技術成為相當好的決策支援工具。 本研究之目的為分析某醫學中心藥劑部之門診給藥流程，並利用系統模擬的方法，結合電腦模擬套裝軟體建構藥劑部門診給藥流程之模擬模型。同時利用流程再造的概念，建立不同改善方案的模擬模型。預期能夠從研究結果中取得個案醫院藥劑部未曾紀錄的數據資料，供未來研究或決策參考。而模擬的結果資料則可以供決策者制定對於個案醫院較佳的流程，縮短作業流程等候時間並提升作業效率。 研究結果發現個案藥劑部門診流程確實存在瓶頸，而縮短作業時間的方式有減少作業中瑣務發生的機率並且縮短解決瑣務的時間。在其它縮短時間可能的方案中，以增加發藥窗口為最有效的方案，增設印表機次之。另外本研究發現資源配置比例的適當性相當重要，將影響整體系統的流暢度與作業時間。因為本模擬研究是針對單一家醫院藥劑部進行系統的分析研究，若非各藥劑部系統相似，將無法將研究結果套用到其他藥劑部。但對於其他計時研究或是未來想要從事模擬研究的人員，本研究相當具有參考價值。

Since the National Health Insurance began, the medical industry environment became more competitive. Improving service quality and lowering expenditures in order to promote the operating efficiency and effectiveness of the organizations have become the key factors for the organizations to survive. “Waiting” is one of the important factors that affect customer satisfaction. Shortening the waiting time could improve satisfaction and service quality. Science evidence is very important at present; therefore, we need more evidence-based policy-making evaluation before we implement new plans. At this time, simulation skill becomes an appropriate decision making supporting tool. The objectives of this study are analyzing outpatient drug dispensing process of a medical center, and implementing the theme and computer technique of simulation to build outpatient drug dispensing process models. Increasing resources is the easiest way to solve waiting problem, but resources are limited and rare. It is the most important issue for managers to know how to allocate the limited resources on right places. Furthermore, the investigators use process reengineering concept to build several alternative models. This study acquired data that were never been recorded in the pharmacy department before, and these data could be used for further research or decision making. Also, the results of the simulation can help managers to make better process, shorten the waiting time, and improve service efficiency. The results of study discovered that there are bottlenecks in the outpatient drug dispensing process. Operational time can be saved by different ways; such as reducing the probabilities of dealing with unnecessary tasks and finish errands by using less time. In the other aspects, increasing the number of drug dispensing windows is the most effective way to shorten operation time, and the second effective way is increasing the number of printers. The result also found that the allocation appropriateness of resources is very important because it will affect the fluency of process and operation time. This is a case study of a pharmacy department of one hospital; therefore, the results may not apply to other hospitals whose systems are different. However, this study is very referable for researchers who engaged in time study or simulation study.