透過系統模擬規劃無痛胃腸鏡檢查中心資源配置

Abstract

背景與目標：隨著國人逐漸重視胃癌與結腸直腸癌對健康的威脅，以及衛生單位強力推升大腸癌篩檢率的影響下，胃腸鏡檢查的需求逐漸增加。醫療機構管理者在規劃增加服務量的過程中，必須面對產能規劃、資源利用率衡量以及成本控制等問題。在複雜的服務系統中，資源項目的交互影響使得資源配置難以單純地從單一因子變動的研究中得到充分地解釋，因此本研究的目的在於利用系統模擬工具，同時考慮13種資源項目以及顧客來到之間隔時間，提出一套融合資源配置、預約制度以及成本結構的綜合管理系統，做為改善胃腸鏡檢查效率之參考。 研究方法：本研究應用作業管理、作業研究等理論，藉由系統模擬的軟體工具，以反應曲面法的概念為方法，針對研究對象的檢查流程系統進行資源配置的研究，找出最低資源水準。在控制受檢者等候時間不超過二十分鐘的限制下，將資源配置系統與預約報到系統做整合，提出最低資源配置水準以及間隔顧客來到時間的規劃表，並分別對八小時、十二小時與二十四小時營運的時間方案以及一到六條服務產線的情境做一全面性的分析。最後以資源利用率為指標，提出最佳的資源規劃情境，並檢視最佳規劃情境的每人平均固定成本。 研究結果：本研究找出三種時間方案及六種產線數情境下的最低資源配置水準，並得到八小時及十二小時方案中，設置兩條以內的產線數可使胃腸科醫師的利用率較高，達70％以上；二十四小時方案中，設置三條以內的產線數可使胃腸科醫師利用率達70％以上的結果。而每人平均固定成本的計算，三種時間方案皆以設置三條產線時為最低。 研究結論：在胃腸科醫師利用率以及每人平均固定成本的考量下，八小時及十二小時方案中，設置二條產線數是最佳的規劃；在二十四小時方案中，設置三條產線是最佳的規劃。

Background and objectives：Resulting from more concern about threats of Stomach Cancer, Colorectal Cancer and the strong promotion of Colon Cancer Screening by health sector, the demand for Gastroscopy and Colonoscopy rises rapidly. With more demand, health providers have to face the management issues of capacity planning, utilization measurement, and cost control more carefully when they plan to increase their supply. In a complex service system, it’s quite difficult to figure out a better resource allocation under complicated interaction driven by resources through the study of single factor. Therefore, this study aims to improve efficiency of gastrointestinal endoscopy procedure through the research upon resource allocation of thirteen resource factors and hiatus between customers’ arrival simultaneously. The managerial tool provided includes information of resource allocation, appointment system, and cost structure. Method：Various theories in the field of operation management and operation research are applied to find out the minimum appropriate volume of resources in gastrointestinal endoscopy procedure, primarily by simulation software and response surface methodology. Under the constraints of waiting time within 20 minutes, resource allocation and appointment system are integrated to complete managerial table and comprehensive analysis given 8 hrs, 12 hrs, and 24 hrs case and six scenarios of 1 to 6 service lines. Finally, the best scenario is found by resource utilization rate and average fixed cost per client in the scenario is shown as well. Result：This study presents minimum resource level under three cases and six scenarios. The results indicate that in both 8 hrs and 12 hrs cases, setting with less than or equal to two service lines could make utilization rate of gastroenterologist more than 70%, and in 24 hrs case, setting with less than or equal to three service lines could make it more than 70%. Additionally, the average fixed cost per outpatient will decline to the lowest amount while setting three service lines for each case. Conclusion：While considering the utilization rate of gastroenterologist and the average fixed cost per outpatient, setting with two service lines in both 8 hrs and 12 hrs cases is the best solution and setting with three service lines in 24 hrs case is the best solution.