由麻醉部的運營看醫學中心的管理

Abstract

醫療環境不斷的在改變，健保制度出現對於給付的總額限制、公務預算的不再編列、新的大型醫院競爭者的不斷出現、社會對於台大醫院的期待、以及醫療評鑑制度對醫學中心的要求不斷提高，這些對於台大醫院的經營管理形成巨大的挑戰。沒有健全的管理與財務系統支持，醫院無法做到永續經營。根據衛生福利部公布之醫院財務報告，發現台大醫院在公家機關人事及會計制度限制之下，仍能在競爭激烈的台灣醫療環境中有不錯的財務表現。台大醫院在追求財務結構健全的同時，也持續提升醫療品質與服務態度，為民眾心目中台灣最受信賴的醫學中心。所以本研究是要由不同層面來了解台大醫院的組織架構與管理模式。由於要拆解一個這麼大的醫院十分複雜，所以我們就藉由一個共同科—麻醉科的日常運營來解析，由麻醉科之營運管理面、財務績效面以及人力資源面來看台大醫院的醫院管理。 台大醫院在歷任院長的努力與領導之下，一步步朝著健全管理制度與財務績效方向前進。台大醫院自80年新大樓啟用後即積極建構醫院經營管理體系。於85年爭取到績效獎金制度，導正了以前不同工同酬的弊病。同時也實施成本會計制度以強化營運效率，還有開始服務品質促進，進行流程再造與服務再造。再來積極向台灣大學管理學院取經，導入企業領導管理思維並培育管理人才。88年開始醫院願景策略及醫療體系的建構，92年又側重服務流程再造與營運績效提升，開始推行平衡計分卡及策略地圖做目標管理。校準(align)員工，調整他們朝同樣的方向前進。99年更是接受JCI國際醫院評鑑，利用外部稽核把台大醫院長久以來根深蒂固的思維與流程徹底翻轉。也就是這樣不斷導入與時俱進的領導管理觀念與制度，並加以確實執行。並定期檢視內在與外在環境之變化，來作為策略調整之依據。使得台大醫院充滿了朝氣，大家努力朝共同的使命與願景邁進。台大醫院也努力塑造適合學習成長的環境，當醫院的規模、經驗和學習結合起來，就產生一個良性循環，能夠迅速改善醫院所提供的價值，促進卓越的表現。台大醫院也特別針對醫院管理人才的培育，這有助於醫院長遠的領導與管理，在醫學中心並不多見。台大醫院非常看重人力資源，認為重要性並不低於實質資本。醫院經由對人力資源的投資，在專業上可形成照護的良性循環；在管理上可校準大家朝共同的願景前進。當醫院的口碑愈好，品牌優勢便更明顯，患者會源源不絕地湧入。在良好的領導與管理之下，台大醫院不需要特別追求利潤，醫院的合理利潤仍會不斷提升。我們認為與時俱進的領導管理之觀念及制度、以及對於人力資源之培育與投資，是台大醫院持續具有競爭優勢的關鍵因素。 台大醫院未來還有空間可以在人才羅致與培育、醫療設備、與醫療技術面上再加以改善。然而再怎樣變革，也還是要受到公家機構人事與會計制度的規範與限制，未來若能適度鬆綁，相信以台大醫院目前領導管理之方式，定能更朝亞洲第一的目標邁進。

A robust management system and healthy financial support is the prerequisite for the sustainable management and development of a medical center. The environment of medical care is consistently changing. The limited total payment of National Health Insurance system, no longer support by the official budget, the emergence of new large-scale hospital competitors, and higher expectations of the Taiwan society all contributed to the huge challenge to the hospital management of National Taiwan University Hospital (NTUH). According to the public hospital financial report by the Ministry of Health and Welfare, the NTUH has a good financial performance in the highly competitive medical environment in Taiwan, even under the regulation and restriction of the personnel and accounting system of government. While pursuing a sound financial structure, the NUH has continued to improve its medical quality and service attitude, and is the most trusted medical center in Taiwan. Therefore, the aim of this study is to explore the organizational structure and hospital management model of the NTUH from different levels. Since it is very complicated to analyze such a large-scale hospital, we will study it through the operation of the Department of Anesthesiology. From the different parts of operation in Department of Anesthesiology such as daily operational management, financial performance and human resources, we can clarify the mechnisms of hospital management of NTUH. Under the efforts and leadership of successive deans, NTUH has gradually moved toward a sound management system and financial performance. Since the opening of the new building in 1991, the NTUH has actively constructed a hospital management system. The implementation of the performance bonus system in 1996 has improved the disadvantages of equal pay for different jobs. At the same time, the cost accounting system is implemented to enhance operational efficiency, as well as process and service reengineering to promote service quality. The NTUH also introduced current management thinking from National Taiwan University College of Management and cultivate management talents. In 1999, the NTUH began to construct its own medical system and vision strategy. In 2003, it began to implement balanced scorecards and strategic maps to align employees and adjust them in the same direction. The NTUH used external audits of “Joint Commission International Hospital Accreditation” to completely reverse the long-rooted thinking and process in 2010. NTUH reviews changes in internal and external environments regularly as a basis for strategic adjustments. NTUH also strives to create an environment suitable for learning and growth. A virtuous circle is created with the combination of the scale, experience and learning of the medical teams, which can quickly improve the value provided by NTUH and promote excellence. NTUH also specifically targets the cultivation of hospital management talents, which contributes to the long-term leadership and management of the hospital. It is rare in medical centers. NTUH attaches great importance to human capital and believes that the importance is not lower than the real capital. Through the investment in human resources, the NTUH can form a virtuous cycle of medical care in the profession; in management, NTUH can align everyone toward a common vision and target. When the hospital's word of mouth is better, the brand advantage will be more obvious, and patients will continue to flow in. Under good leadership and management, the NTUH does not need to pursue profits, and the reasonable profits of the hospital will continue to increase. We believe that the concept and system of leadership, management and the cultivation and investment of human resources that are advancing with the times are the key successful factors for the continued competitive advantage of NTUH. In the future, there will be room for the NTUH to improve its talents cultivation, medical equipment utilization, and medical technology advancement. Despite of the willing to change, it is still subject to the regulation and restriction of the personnel and accounting system of public institutions. If the restriction can be loosened in the future, it is believed that NTUH will be able to move toward the goal of becoming Asia's number one university hospital under the current model of leadership and management.