健康照護產業作業研究最佳化： 以臺北榮總麻醉護理師排班個案為例

Abstract

在過去的幾十年中，醫院的成本壓力急劇增加。這強調成本控制迫使醫院管理階層不得不以更業務導向的方式來營運。為了要達到以降低的成本來提供高質量的服務。作業研究被廣泛的應用在醫療照護產業，藉此來消除資源的低效利用。手術室被認為是帶動醫院發展的主要引擎，一個普遍問題是醫護人員每天（甚至每小時）的工作量壓力變化很大，高峰時工作人員難以應付負荷，低潮時工作量太低有巨大的成本浪費。在臺北榮總麻醉部工作的麻醉護理師們常常因為手術麻醉的時間不確定而工作到很晚的時間，造成護理質量下降，病患安全有疑慮而院方也必須付出更多人力成本。 本研究的目的是為了探索在這個過程中院方管理上所面對的挑戰與策略作為，如何透過護理師輪班班別的改變及作業研究技術來協助實現這一目標，達到多贏的目標。由於護理服務在整個醫院療服務中佔有十分重要的地位，透過合理的排班系統可以保證護理品質、並改善護理師的身心健康與生活品質、本研究透過作業研究的最佳化模型來評估如何減少麻醉護理師的工作時間和減少超出計劃的加班時間，並採取積極措施來減少資源浪費，包括最適有效的員工分配和適當班別安排，通過大量的計算實驗，我們提供了節省成本的機會和所需解決時間的想法。利用這種模型的擴展來獲得最佳化的護理排班，可以提供解決護士調度問題的方法。 本研究應用了臺北榮民總醫院麻醉部的實際個案，根據實際個案可以真實呈現所面對的巨大挑戰，結合相關的排班策略、最佳化模式、資料數據分析、因應差異性與特殊性，同時面對院方、外科、開刀房以及麻醉課題，由於環境的不同潛蕆著很大的風險，透過研究資料蒐集歸納分析，進一步探討相關議題，找到最佳的致勝方針，提供實際的策略思維及變革行動，在研究過程中也產生了許多實用的研究結論，同時也驗證了作業研究的實用性，期望這些研究成果可以提供給臺灣以及全世界的麻醉及手術室做為護理師排班的參考。

Over the past decades, cost pressures on hospitals have increased dramatically. This emphasis on cost control forces hospital management to operate in a more business-oriented manner. In order to achieve high quality services with a reduced cost, operations research is widely applied in the healthcare industry to eliminate inefficient use of resources. The operating room is considered to be the main engine driving the development of the hospital. A common problem is that the workload of medical staff varies greatly every day (or even every hour). It is difficult for staff to cope with the load at peak times, and the workload is too low at low tide, which has huge costs. waste. Nurse Anesthetist who work at the Taipei Rong General Hospital often work late due to the uncertain timing of surgical anesthesia, resulting in a decline in the quality of care, patient safety concerns and the hospital's need to pay more labor costs. The purpose of this research is to explore the challenges and strategies faced by hospital management in this process, and how to help achieve this goal by changing the shifts of nurses' shifts and homework research techniques to achieve a win-win goal. Because nursing services occupy a very important position in the entire hospital treatment service, a reasonable scheduling system can ensure the quality of care, and improve the physical and mental health and quality of life of the nurses. This study uses an optimization model of operational research to evaluate how Reduce the working hours of anesthesia nurses and overtime beyond the plan, and take proactive measures to reduce waste of resources, including the most effective and efficient staff assignment and appropriate shift arrangements. Through a large number of calculation experiments, we provide opportunities for cost savings and Idea of the time required for resolution. Utilizing the extension of this model to obtain optimized nursing scheduling can provide a solution to the problem of nurse scheduling. This study uses the actual cases of the Department of Anesthesia, Taipei Rongmin General Hospital. According to the actual cases, it can truly present the huge challenges faced, combined with relevant scheduling strategies, optimization models, analysis of data, and response to differences and specificities. At the same time, in the face of hospitals, surgery, surgery rooms, and anesthesia issues, due to different environmental risks, there is a great risk. Through research data collection and analysis, we will further explore related issues, find the best winning strategy, and provide practical strategies Thinking and change actions have also produced many practical research conclusions during the research process. At the same time, they have also verified the practicality of operational research. It is hoped that these research results can be provided to Taiwan and the world's anesthesia and operating rooms as nurses' scheduling Reference.