以創新組織設計提昇病患價值與管理效能─以急診為例

Abstract

全民健保的實施降低了民眾的就醫門檻，而遍佈的醫療機構也提供民眾高度的就醫方便性。雖然保障了民眾的生命健康及安全，但卻也是導致急診壅塞與醫療資源被濫用的原因。衛福部的統計報告指出，在各家醫院的急診病患中，檢傷分類第3、4、5級的病患，也就是所謂的輕症病患，占了總病患量的八成以上。急診壅塞的現象從2000年左右開始有學者注意到，到如今急診壅塞已經不再是個現象而已經成為常態。但是光從政策面去限制輕症患者就醫的效果有限，甚至會造成民眾反彈。運用精實畫布的分析，成立一個新的部門將非危急的輕症患者引導到特定的區域治療，解決急診因為過多非危急的輕症患者就醫所造成的處置效率低落及就醫體驗不佳的問題。透過設立快捷中心及搭配智能App的使用，幫助急診整體效率提升及流程改善，讓每位急診患者都能得到最適當的急診醫療照護。快捷中心及智能App產生的效率，可以降低患者需要付出的機會成本；即使自付金額支出可能提高，但是降低的機會成本及良好的就醫體驗，患者最終得到的價值仍舊是增加的，也是支持快捷中心這個商業模式可以運行下去的因素，透過縝密的流程修改及制度設計，利用智能App向病患及家屬傳達正確的急診就醫觀念及提供有助於患者維持健康狀態的衛教資訊，降低患者在急診等候的時間機會成本，增加患者的就醫體驗，從而創造出更高的價值。

Implementation of the National Health Insurance system in Taiwan has lowered thresholds for medical treatment, and the wide distribution of medical institutions all over the country also provide people with a high degree of healthcare accessibility. Although this guarantees accessibility of healthcare, it may also cause abuse of emergency medical resources. According to a statistical report from the Ministry of Health and Welfare, among the emergency patients in various hospitals, patients with triage levels of 3, 4, and 5 (non-critical cases) account for more than 80% of emergency department visits. This phenomenon of emergency department overcrowding has been observed by scholars since 2000, and by now this has become such an everyday occurrence that emergency room overcrowding is no longer considered a phenomenon. However, restricting accessibility of healthcare from patients with minor conditions using political means may lead to backlash. This study used the lean canvas model to establish a new department that guides low-acuity patients to specific areas for treatment, a proposal that can help to solve non-efficiency and poor patient experiences in emergency rooms due to overcrowding caused by non-critical patients. Through the establishment of our Agile Center and accompanying smartphone app, the overall efficiency of emergency rooms can be improved, and every emergency patient can get the most appropriate care. This efficiency generated by the Agile Center and smartphone app can reduce the opportunity costs of patients, and even though out-of-pocket monetary costs may be increased, this lowering of opportunity costs and enhanced patient experiences can still increase total values for patients, making it feasible for the business model of the Agile Center to be implemented. Through process and system redesign and use of our smartphone app, proper health and aftercare education information can be conveyed to patients and their families, helping patients maintain their health, reducing emergency room waiting times and opportunity costs for patients, enhancing patient experiences, and generating higher values.