醫療機構對醫療器材維護服務品質之管理決策模型探討

Abstract

醫院是跨領域且多學科的實體，醫院的管理與決策所考量的面向，雖然相當複雜且具挑戰性，但一定要持續專注於醫療品質與病人安全這兩項核心價值，同時需兼顧醫療技術深度與新科技的投資。如何能夠妥善維護醫療器材的服務品質，是很重要的、很關鍵的要素之一。醫療器材的維護可以選擇自行營運或委外，本論文將探討建立四種維護模型，提供醫院在不同內外部環境，選擇符合自身條件之最佳的維護管理決策模型，發揮醫療器材維護服務品質的最佳管理效益。從醫療器材維護服務品質密切相關的議題，包含安全、成本、人才之探討，進行維護管理決策模型之分析。 從國內外文獻查考與引用醫療器材維護管理層面相關共191篇，篩選與醫院管理、病人安全、醫療品質、成本效益及交易成本決策等30篇，從管理部門之建立到維護服務品質之探討，如病人安全、醫療品質、營運績效與法令遵循等文獻參考。本論文從管理決策考量，建立以自行維護率的角度定義包含M1(>90%)、M2(90%~65%)、M3(65%~35%)、M4(<35%)等四種模型，以符合實際的情境。從四種模型之特性分析，進一步探討維護服務品質相關之模型特徵，而產生兩個層面之特徵項目，進行問卷設計與調查，並獲得明確之結果與分析驗證結論。 從醫療器材維護服務品質之管理決策考量，得到各個層面的結果幾乎都是以醫療器材的使用安全為首要。要達到這個目的，都要有足夠醫工專業的人才，與培育訓練所需檢測設備與部門組織的成本投資，來發揮人才功用與因應風險的潛能，醫療器材的使用安全需要醫工人才與成本的支撐，才能有好的品質。結論與建議發現病床數規模與醫療器材量正相關，醫工人力也是一樣的結果，越大型的病床數，維護模型是M3→M2→M1的趨勢。個別設備是大型屬M4模型，中型是M2與M3模型，小型是M1模型。維護品質的相對重要性總結是安全＞成本＞人才。人才構面在各病床數之特徵項目重要性，以合格的醫工專業人才和自主營運能力明顯重要於醫工工作年資，也是M1模型與M2模型必備的特徵。未來展望醫院的營運，可依據病床數規模、醫療器材設備量與醫工專業人才之現況需求，來決定個別設備之維護模式，妥善分配自修或委外的比例，配合M1、M2、M3及M4的模型，是很具實務需求的醫院營運模式。

A hospital is a cross-field and multi-disciplinary entity. Although the considerations faced by hospital management and decision-making are quite complex and satisfying, they must focus on the two core values of medical quality and patients. At the same time, it is necessary to safely consider the depth and innovation of medical technology. Investment in technology. How to strengthen and maintain the service quality of medical equipment is one of the most important and critical foundations. For the maintenance of medical equipment, either self-operated or outsourcing model can be considered. This thesis will explore the establishment of four maintenance models to provide hospitals with the ability to choose the best management decision-making model that meets their own conditions under different external environments and implement the quality of medical equipment services. From the considerate of the maintenance of medical equipment and the service quality, including safety, cost, and talent, the thesis proposed an analysis of the maintenance management decision-making model. A total of 191 articles related to the maintenance and management of medical equipment were reviewed, and 30 articles were referred as reference that related to hospital management, patient safety, medical quality, cost-effectiveness and transaction cost decision-making. Based on the establishment of management departments to the discussion of maintaining service quality, such as patient safety, medical quality, operational performance and legal compliance will be the major considerations. Based on the perspective of management decision-making, this thesis establishes four definitions of self-maintenance models, including M1(>90%), M2(90%~65%), M3 (65%~35%), and M4(<35%) to match the actual situation. From the characteristic analysis of the four models, this thesis further explore the model characteristics related to maintaining service quality, and generate two levels of characteristic items. The thesis conduct questionnaire design and investigation, and obtain results and verification conclusions. From the management decision-making consideration on the quality of medical equipment maintenance services, the results obtained at all viewpoints are almost always based on the safety of medical equipment use. In additions, achieve this goal, it is necessary to have enough medical professionals, as well as the cost investment of testing equipment and departmental organizations required for training so that it can unleash the potential of talent functions and respond to risks. The patient safety will depend on require medical equipment medical talents and costs. Only with good support can we have good quality. In conclusion, it is found that the number of hospital beds is positively related to the amount of medical equipment, and the same result is found for medical manpower. The larger the number of hospital beds, the maintenance model trend is M3→M2→M1. Individual large size equipment is the M4 model, the medium size is the M2 and M3 model, and the small size is the M1 model. The relative importance of maintaining quality is safety > cost > talent. The importance of the talent aspect in the characteristic items of each hospital bed number, with qualified medical professionals and independent operating capabilities is more important than the medical working experience, is also a necessary feature of the M1 model and the M2 model. Looking forward to the future operation of the hospital, the maintenance model of individual equipment can be determined based on the number of hospital beds, the amount of medical equipment and the current demand for medical professionals. All the proportion of self-repair or outsourcing can be properly allocated to coordinate with M1, M2, M3 and M4 model that is a hospital operation model with very practical needs.