跨國肝臟移植流程之服務品質探討與設計初探: 以台北市某醫學中心為例

Abstract

背景與目的：為配合政策推動台灣醫學中心的醫療外交，並且貢獻於全球衛生，許多醫學中心除了觀光醫療以外陸續開始發展移植手術等重症國際醫療服務。在東南亞地區，肝癌是第二常見的癌症，而在低收入或醫療照護及健保政策尚未普及的國家，仍有許多需求者沒有管道接受治療。目前我國幾乎沒有研究者探討過重症國際醫療的病人經驗、服務品質，亦無研究是針對東南亞地區病人來台就醫的經驗。本研究收集整合性的觀點，主要目的為: (1)了解跨國肝臟移植手術流程安排的現況與遭遇問題; (2)服務品質探討：以緬甸的少數個案為主要研究對象，深入探索病人與其家屬對於來台接受肝臟移植手術的就醫經驗與建議; (3) 流程設計初探：善用標竿學習與流程管理的理論、收集醫院外部的經驗與建議，作為流程設計的改進參考。 研究方法：本研究透過質性深度訪談的方式收集資料。研究對象分成三組：(1)國際（緬甸個案）病人及家屬受訪者、(2)個案醫院內部有相關經驗之受訪者及 (3)國內其他有重症國際醫療服務經驗的醫院受訪者。資料分析是透過編碼進行訊息歸類，並從中整理出呼應研究主題的核心概念。 結果：研究參與者包含曾來台灣接受並完成手術的個案病人1名、曾陪受贈者於個案醫院接受治療的家屬8名、個案醫院內部醫護及行政人員5名、其他醫院的相關經驗者6名，共20位。研究結果發現，病人與家屬對個案醫院建立高度信賴感與安心感，對服務品質的正面評價與感受多過於改善建議; 個案醫院因軍方單位的性質，經營方式較為保守; 透過訪談國內其他醫院的受訪者整理出十項國際醫療服務品質與流程改善策略; 三組的研究對象中接有人提到目前我國針對特定國家外籍人士的醫療簽證規定造成申請來台就醫的不便。 結論：國際病人在就醫過程中，除了醫療品質與技術的考量以外，對於語言服務、溝通、目的地的社會資源以及就醫管道是否方便等非醫療的事項亦相當重視; 欲發展重症國際醫療的醫院可透過參考國內外醫院的過程面策略，提供國際病人更加友善的服務與就醫環境。政府對特定國家人士的醫療簽證鬆綁或調整可幫助提升醫療服務的可近性。

Background & Purpose: With the mission to promote medical diplomacy and global health, a number of medical centers in Taiwan start to provide critical or intensive health services such as liver transplant surgeries for inbound medical tourists. Liver cancer is the second most common cancer in Southeast Asian countries where many people, with lower income or fewer medical resources and healthcare coverage, still lack access to treatment for serious illnesses. There are very few studies that analyze patient experience and service quality of medical tourists who come to Taiwan for surgical treatment. Almost no studies in Taiwan explore the experience of patients coming from Southeast Asian regions. This study collects integrative perspectives for three purposes: (1) To understand current processes and challenges of cross-national liver transplant surgeries (2) To explore service quality from in-depth experiences and feelings of patients and their family from the country of Myanmar (3) To provide preliminary suggestions for process improvement by benchmarking practices and experiences of other domestic hospitals. Methodology: This research uses qualitative in-depth interviews for data collection. The interviewees are divided into 3 groups: (1) international patients and family from Myanmar, (2) health providers and administrators from case-study hospital with relevant experience, and (3) health providers and administrators from other hospitals with relevant experience. Data analysis is conducted by using NVivo10 to code and categorize interview data, and form various emerged themes. Results: Interviews were conducted on 20 participants, including 1 patient who has undergone liver transplant surgery, 8 family members with previous or current accompanying experiences to hospitals; 5 participants from the case-study hospital, and 6 participants from other hospitals. The findings show that patient and family members have built a high degree of trust and sense of security towards the case-study hospital, and provided more positive feedback than suggestions on the service quality of the hospital. The case-study hospital interviewees all mentioned the limitations on internationalizing medical services due to the conservative business practice of a military hospital. Ten strategies of process improvement in medical tourism of surgical treatment are generated after conducting interviews with other experienced hospitals in Taiwan. Some interviewees from all three groups mention the difficulties and inconvenience of current medical visa policies, especially the regulations for specific areas such as Myanmar. Conclusion: During the process of seeking and receiving medical treatment abroad, patients not only consider healthcare quality and clinical skills as important, but also raise concerns about language translation services, communications, social resources at the destination area, and convenient access to the destination hospital or country. Hospitals planning to internationalize health service of serious illness could use process-based benchmarking and refer to the strategies of other experienced hospitals for creating a medical-tourist-friendly environment. The deregulation or adjustment of current medical visa policies for special areas could help improve the patients’ accessibility to medical treatment or major surgeries that require high level of skills.