以系統動力學探討創新醫療模式之績效 －以台大醫院病患自控止痛服務小組為例

Abstract

近年來，醫療服務產業處於競爭激烈的環境中，醫療服務機構面臨醫療成本高、醫療資源不足的問題，而如何衡量及提升組織績效等問題備受關注，醫療服務機構為求提升經營績效、永續經營，應導入更有效的管理方法，Christensen認為，醫療服務產業依其服務項目特性，可分為三種不同的營運模式：問題解決工作坊(Solution Shop)、加值流程事業(Valued-adding Process Business)以及促進網絡(Facilitated Networks)，每個營運模式各自有其管理重點，在衡量組織績效時，各項績效指標的重要性也有所差異。

平衡計分卡(Balanced Scorecard, BSC )為近年來廣受實務界認同的績效評估方法，但部分學者提出平衡計分卡推動的效益不如預期，而平衡計分卡並未完整考量績效衡量指標間相互影響的因果關係，也忽略了推動政策時可能產生的時間遲滯效果。透過系統動力學(System Dynamics)，可更精確釐清各績效指標間因果關係所產生的反饋效果，並考量時間遲滯的影響，使推動平衡計分卡的效益提升。

本研究將依據Christensen提出的三種創新醫療服務模式將醫療服務產業作分類，在平衡計分卡（Balanced Scorecard, BSC）的架構下分別建立績效指標，並運用系統動力學方法，釐清各績效指標間之因果回饋關係，並以台大醫院病患自控止痛服務小組為個案討論對象，實際進行動態模擬，找出影響績效之關鍵驅動因子，提供個案組織策略發展的建議。

Healthcare service industry is facing the problems of high cost and insufficient resource. In this highly competitive industry, how to evaluate and raise performance becomes an important issue. In order to achieve better performance, Clayton M. Christensen mentioned that healthcare service providers should be separated into three business models, Solution Shop, Valued-adding Process Business and Facilitated Networks, which depends on what kind of the healthcare service they provide, and each model has its own management focus and performance evaluation indices. Balance Scorecard (BSC) is a very common tool for performance evaluation nowadays. However, BSC does not consider the effect of time lag and does not consider the interactions between key performance indices completely either. On the other hand, System Dynamics has the ability to deal with these problems. By integrating BSC and System Dynamics, performance evaluation would be more accurate and appropriate. This study introduces the three business model Christensen mentioned, develops BSC for each model, and finds the interactions between the key performance indices, and develops the casual loop diagram in System Dynamics of each model. Based on the casual loop diagram in System Dynamics, this study uses System Dynamics software Vensim to build, test and verify model for National Taiwan University Hospital (NTUH) Patient Controlled Analgesia (PCA) program. Finally, based on the results of simulation, several policies for performance improvements are suggested for the NTUH PCA team.