品質管理活動推行的廣度、深度與醫院績效關係之研究

Abstract

本研究主要目的有三: (一) 探討品管活動推行的廣度與醫院績效的關係；(二)探討品管活動推行的深度與醫院績效的關係；(三)探討品管活動推行的廣度和深度，影響的是過程性績效亦或是整體性績效。 本研究在各醫院推行品管活動的廣度(推行品管活動的項數)和深度(推行時間的早晚期、推行時間的長短期、推行的範圍、員工受教育訓練的比例、持續推行品管活動的項數)之調查，以139家醫院為研究對象，採問卷方式，有效問卷回收率為54 %。在醫院績效方面區分為過程性績效和整體性績效，前者包括:平均住院日、佔床率、病床週轉率、粗死亡率、門診人次、住院人次、門診市占率和住院市占率等八項，後者包括：人工膝關節置換手術傷口表層感染率、人工膝關節置換手術置換物深部感染率和人工膝關節置換手術30天內再住院率等三項。最後再以線性複迴歸模式來分析品管活動推行的廣度、深度與醫院績效間的關係。 本研究主要發現如下: (一)是否推行品管活動未能影響醫院過程性績效 (二)是否推行品管活動會影響醫院整體性績效 (1)已推行品管活動的醫院，佔床率會較高。 (2)已推行品管活動的醫院，病床週轉率會較高。 (3)已推行品管活動的醫院，粗死亡率會較低。 (三)品管活動推行的廣度與深度未能影響醫院過程性績效 (四)品管活動推行的廣度與深度會影響醫院整體性績效 在推行的廣度方面: 品管活動推行的項數越多，粗死亡率越低，門診市占率越高。 在推行的深度方面: (1) 早期推行TQM的醫院，門診市占率較高。 (2) 長期推行TQM的醫院，門診市占率、住院市占率較高。 (3)全院性推行標竿學習的醫院，佔床率較高。 (4)推行QCC改善案期數越多的醫院，病床週轉率會較高。 (5)持續推行品管活動項數越多的醫院，門診人次、門診市占率和住院市占率 皆較高。 本研究更進一步發現：當推行品管活動的項數超過11項以上，持續推行品管活動的項數超過8項以上，醫院績效會較好。結果顯示，品管活動的推行有助於提昇醫院績效，且品管活動推行的廣度與深度皆會影響醫院整體性績效中的營運績效和市場績效。因此，本研究建議衛生主管機關應支持各級醫院推行各項品管活動，也建議醫院管理者品管活動的推行需要長期、全院性且持續不斷地推動才能有所成效。

The purposes of this study include: first, to explore the relationship between the scope of quality management activities and the hospital performance; second, to explore the relationship between the intensity of quality management activities and the hospital performance; finally, to examine the scope/intensity of quality management activities mainly affecting the process performance or the hospital overall performance. The scope of quality management activities refered to the item of implementing ; the intensity of quality management activities refered to the early or late of implementing, the period of implementing, the ration of trained employees and the item of continuously implementing.The study samples included 139 regional (and above) hospitals in Taiwan. A questionnaire were mailed to each hospital for collecting the information that the scope/intensity of quality management activities, and the valid reponse rate was 54 percent. Eight hospital overall performance indicators wre selected from the Department of Health database over the pase decade (1999-2008), including occupancy rate,bed turnover rate,crude death rate, outpatient visits,inpantient visits, outpatient market share and inpatient market share. The process performance indicators were selected from the Department of Health’s report card, including total knee replacement surface infection rate, deep infection rate and 30 days hospitalization rate. Regression model was applied to analyze the relationship between the scope/intensity of quality management activities and hospital performance. The results as follows: 1. The quality management activities didn’t have remarkable impacts on hospital process performance. 2. The quality management activities had remarkable impacts on hospital overall performance, such as occupancy rate , and crude death rate. 3. The scope/intensity of quality management activities didn’t have remarkable impacts on hospital process performance. 4. The scope/intensity of quality management activities had remarkable impacts on hospital overall performance. (1) The outpatient market share of early implementing TQM was higher than implementing late. (2) The outpatient and inpatient market share of implementing over a long period of time were higher than that implement shortly. (3) The occunpancy rate of implementing Benchmarking holisticly was higher than non-holistic implementing. (4) The bed turnover rate of implementing QCC more number is higher than that less number. (5) The outpatient visits, outpatient and inpatient market share of the more items of implementing continuously were higher than less items. In addition, when the items of implementing were above eleven and the items of continuously implementing were above eight, the hospital overall performance would be better. In conclusion, the quality management activities indeed had positive effects on hospital performance, and the scope/intensity of implementing both affected the hospital overall performance. According to these findings, we suggested the authorities should support hospital to implement quality management activities, and hospital administrators should implement over a long term , hosliticly and continuously.