重症照護單位專責醫師制實施前後對醫療品質、營運策略及組織向心力之比較分析

Abstract

在政府實施全民健保後，明顯影響到醫院的獲利能力，如何藉由「經營績效」的衡量來達成降低成本提高效益之目標，有效地提升醫療服務品質，保障民眾就醫權益是目前醫療機構高階管理者最關心的議題。而今醫療糾紛頻傳，急重症人力日漸減少，然而不論是新制醫院評鑑、抑或急重症分級評鑑，對於醫療人力的要求也日益增加。 評估加護病房設置專責重症專科醫師(Intensivists)前後對於照護品質和醫療資源利用之效益，在國內外文獻已多所論述，但相關文獻多來自醫學中心等級之醫院，在中型醫院之實行成效仍未獲得實證或經驗報告，本次研究探討一個中型區域教學醫院在實施重症加護中心專責醫師制度後對病患醫療品質及組織員工向心力的研究，並期望對醫院的營運策略能提供建議。研究者將以平衡計分卡的概念就財務、顧客、內部流程及成員學習成長四個構面作分析，利用複迴歸分析、獨立t檢定評估醫院經營績效，個案單位醫療品質及醫療資源的耗用，接下來輔以實施對單位內的醫護同仁的深度訪談，藉以瞭解專責制度實施前後對臨床第一線醫護同仁所帶來的衝擊。 本研究發現，實施專責制度後，病患之醫療成果及第一線護理人員的工作滿意度有明顯增加，但個案醫院之整體績效卻是衰退的。經營重症專責加護病房所產生的儀器設備成本甚高，就區域醫院層級而言，機構財務基礎較單薄，醫師人力亦相對缺乏，經營此種高成本專業單位也增加了醫院的經營壓力。對經營者而言，應將妥善的勞務分工及績效分配列為首要目標。最後，本研究針對評估結果提出改善建議，提供主管機關政策制訂及國軍醫院內部經營管理之參考。才能順利推動制度的實行及醫院的永續經營。

The abilities of hospital profitability were significantly affected after the government implemented the NHI since 1995. How to achieve the target to reduce cost and improve effectiveness by operating performance measure to enhance the quality of medical services, and to protect the public medical treatment equity is high-end of the medical institutions managers who most concerned about. Today, medical malpractice appears frequently and severe human dwindling, however, whether the new hospital accreditation, or the evaluation of acute severe classification for medical manpower requirements also increasing. Assessing ICU setting dedicated the intensive specialist physicians (Intensivists) before and after the effectiveness of the quality of care and utilization of health care resources have been discussed in the literature. But the related literatures were almost from the Medical Centers. The effectiveness of the implementation of the medium-sized hospital yet empirical or experience reports. The study represents a medium-sized regional teaching hospital that conducted physician system in intensive care center to improve patient quality of care, employees' loyalty, and expect to provide recommendations to the hospital's operating strategy. Researchers will use the framework of balanced scorecard which includes four dimensions: financial, customer, internal process, and learning and growth of member to analysis. The analysis method would include multiple regression analysis, independent t-test to assess the hospital management performance units for quality of care and medical resources consumption next-depth interviews supplemented by implementing the medical staff within the unit. Thus we can understand the impact of clinical first-line medical staff face the implementation of the intensive specialist physicians. The conclusion of study recognized the outcome of the patient's medical and first-line nurses' job satisfaction has increased significantly after the introduction of a dedicated system. However the overall performance in the case hospital recessed. Based on the concern of high cost of the equipment to operate severe dedicated ICU, the agency's financial foundation, lack of physician manpower, operating such high-cost specialized units has also increased the pressure on the operation of the regional hospitals. Operators, as a primary objective should be a proper division of labor and performance allocation. Finally, this study proposed improvements to the assessment results, provide the competent authorities in policy formulation and the reference of the internal operation and management of military hospitals. To promote the system to implement and sustainable management of the hospital.