評估管理病患抵達行為對候診時間與醫療品質的影響

Abstract

候診時間過長一直以來都是我國醫療產業與病友揮之不去的夢魘。對病友而言，前往醫院看診的目的是求得藥到病除，然醫院內充斥著各種無形的病菌，容易藉由擁擠的候診人潮交互傳染，進而造成病患身心上極大的損害與威脅，尤其在濫用抗生素與院內感染情形嚴重的台灣，候診的管理更不容輕忽；再者，由於過長的候診時間往往會導致病患對醫療機構心生不滿，如今健保制度逐漸縮編預算與強調醫療品質的同時，如何縮短病患的候診時間以增加病友的滿意度實是相當重要的課題。 過去台灣針對院內排隊管理的研究都是針對候診間的管理、預約掛號制度的成效、排隊領藥的規劃等構面，對於實質降低候診時間的研究仍付之闕如，往往都只能針對增加護士叫號或是加快遞送病例等增加行政事務的方式降低因為無效率所導致的等候時間，而成效也相當的有限。因此本研究試圖將Disney land已經大量採用、效果極佳的虛擬排隊系統（virtual wait）導入醫院候診管理的系統中，在不增加行政體系負擔的前提下，藉此降低病友的候診時間。 虛擬排隊策略必須藉助排隊理論的運用以及系統模擬程式的幫助，透過電腦模擬真實排隊情形，預測不同病患可能的看診時間『區間』，藉此通知病友抵達的時間區間，管理病友的抵達行為，以降低病友的候診時間。然而，醫師的看診行為具有一定的波動性，不若遊樂設施來的穩定容易預測，因此本研究的首要目的即是證明此種管理候診的預測系統確實能夠套用在醫療看診行為中。 經由AWESIM系統模擬軟體與實際針對特定醫師研究的結果顯示，透過虛擬排隊策略管理病友抵達行為確實能夠顯著的降低候診時間、減少平均的候診人數，唯不同醫師具有不同的看診行為與看診時間波動性，因此必須針對不同醫師設計專屬的預測系統，才能確保達成降低候診時間的最佳效果。

The waiting time is always unsolved for both outpatient and hospitals. For outpatient, searching for curing is the purpose, but those sources of contagious full of hospital can easily damage their physical and psychological conditions. Especially in Taiwan, a country with antibiotic-abused, it will never be too careful to manage the waiting. On the other hand, the long waiting time could somehow cause the anxiety and uncertainty of patients and even dramatically decrease their satisfaction in the further. Once the dissatisfaction floods, the government will shrink the subsidiary, lower the rating or even force the hospital to shut down. The brand, reputation and financial support are all relied on patient’s satisfaction, that’s why managing the wait to increase the service quality will always be a hot issue. In the past, researches for managing the wait inside the hospital are mainly focused on appointment system, administration of the hospital and the wait for carrying the medicine or registering. To try to minimize the waiting time for receiving the medical treatment could only fulfill by preventing from the inefficiency caused by the failure of the administration. At the same time, the fruit of the researches are limited. Thus, our research will try to adopt the last system innovated by Disney Land to find out if the successful managing strategy called “FASTPASS” can be executed by medical institution. “FASTPASS” ,so-called “virtual wait strategy”, was created based on waiting theories and computer software. Physical wait can be replaced by simulating in the computer, each customer would be given a time span individually so that he/she could arrive and enjoy the faculty without waiting, which means to minimizing the wait by “scheduling the arrival”. This brand new system has been very well received since 1998 and been adopted comprehensively by Disney land since 1999. Unfortunately, this stunning device since now has only been proved to be useful under some circumstances, and the most important factor for this technology to be successful could be the “deviation” of the capacity and service rate. By that means, unless we prove that the deviation of the service time based on different doctors can at least be overcome, to introduce this concept into medical institution could just be a pie in the sky. Through AWESIM, the software of simulation, we can practically decrease the waiting time by scheduling arrivals and lower the average waiting outpatient, but as different faculties require different FATPASS system, different system for each doctor also must be specialized so that the effect of this virtual waiting strategy can be maximized.