長期照護經營管理關鍵成功因素之研究一以Ａ長期照護中心為例

Abstract

在老人化已是全球共同問題的今日,縱觀我國,其高齡化的倍化速度尤甚於世界各國. 以往需要照顧的老人家可由家人負起大部份的責任,但在家庭功能式微的今日,再兼以疾病的複雜化、慢性化,如何長期妥善照護老人們更衍然成為政府社會迫不及待所應正視的大課題.然在政府強勢主導下,為求好心切,凸顯政黨政績,往往缺乏周延的計劃與遠見,就倉卒端出五花八門的菜單,令人目不暇給,像早期的建構長期照護體系先導計畫等,近期的六星計畫、大温暖套案等,和未來的長照保險等,皆令我等真正關心老人照護問題的團體憂心忡忡. 此外,政府將醫療照護產業(含長期照護)列為我國六大新興產業的美意,我們當然樂觀其成,此舉固然是鼓勵民間企業的積極參與,以提供更多元的不同服務模式,讓有需求的民眾有更多的選擇. 然而隨著眾多營利團體的加入,不僅沖擊到原來已有的非營利組織及小型機構等,更讓我們深思在此良性競爭下,究竟要怎麼做才能真正提供我們老人家們更好更有效率的照顧服務品質,以在這片紅海中爭得一席之地永續經營呢?這些都是當今醫療照護產業必須正視的話題. 有了使命,才有企業,而企業必須奠立循序可行的願景,才能成功.為了達到願景,企業更需制定有效策略.研究顯示藉由平衡計分法可成功地執行策略.如果找到該產業經營管理之關鍵成功因素,再經由平衡計分法的理論驗證,該企業往往可以依循這些關鍵成功因素,繼續再複製進而茁壯成長. 本研究採由實務而來的個案研究法,雖研究對象為單一個案,但因有全國約10家優等機構的佐証,其準確性是可靠的.研究中並就國內長期照護產業的發展過程、體系及模式,產業的結構、特性及競爭狀況作一描述,再舉國外歐、美、亞洲的代表國為例稍作簡介,頗能兼顧理論與實務面,一窺現今產業經營管理的內幕. 研究者繼而憑本身的老人長期照護經歷,更舉本身經營的長期照護機構為個案,分析其機構之概況,說明其願景、使命,機構組織、沿革,機構服務內容及生產線等,探討出目前我國長期照護經營管理之關鍵成功因素, 再以平衡計分法來印證. 研究結果顯示,長照產業的關鍵成功因素為以下七大因素: 環境與設備、領導與管理、顧客面、內部流程、學習成長、財務面、政策面,而且此七大成功因素孩息息相關互相關連,頗值得當今長期照護經營管理者研究參考之. 由於個案機構接了很多公辦民營的單位,故此研究本身還是有其限制的.再則三、四年後長照保險開跑,諸如保險給付對象,保險給付數額多寡等,都還是個變數.據聞,政府為了實施長照保險前所訂的法規,如硬體設備、如人力配置、如評鑑方向越來越朝向醫療化的結果,已使為數不少的機構撑不下去或歇業或研商上街集體抗議.我認為英明的政府應當對此計劃做更周全的討論與規劃,如此才是眾人之福! 一旦真正實施長照保險後,此研究議題還有待以後有心的經營者們繼續探討. 關鍵字:長期照護；經營管理；關鍵成功因素；個案研究

Although the whole world is facing the universal issue of aging, it is especially impending in Taiwan due to a senior population increasing at an unusually alarming rate. Furthermore, in the past, family members served as primary caregivers to the aging but this is not the case anymore due to today’s family structure. In an attempt to address observed societal changes and growing complexities of health problems and chronic diseases, Taiwan tightened its reign on government-sponsored healthcare programs; however, without a focused vision or sound approach, many were haphazard and unrecognized. The Taiwan government tried to promote healthcare, including long-term care, as one of the Six Uprising Industries in Taiwan and encouraged local businesses to provide services in this field to meet the future’s growing need. This brought an influx of for-profit sector engagement into the healthcare business and also impacted existing non-profit and small-sized providers. Now, the provision of quality long-term care while maintaining financial sustainability is a particularly dire issue for providers. A mission-driven business providing any service with sound operations management strategy is more likely to succeed than a business without one. Establishing effective strategies is therefore vital to achieving projected outcomes. Studies show that Balanced Scorecard is a good assessment tool to examine the merits of strategies. If key elements for successful operations management of a business are identified and assessed by using this proven instrument,Balanced Scorecard, the business will have a better chance at continued growth and success. This research is a case study of a private long-term care operation utilizing a pragmatic operations management strategy assessed by this tool. Though a single case study, the findings are reliable and have been validated by nearly ten outstanding organizations nationwide. The study provides an overview of long-term care development in Taiwan including the system and practices, organizational structure and service characteristics, and field competition among providers. It also includes information on long-term care in European countries, United States, and other Asian countries. Overall, it unveils details of today’s long-term care operation and management in Taiwan. The researcher incorporated her own professional experience in managing long-term care facilities, and used one of these facilities for this study. She analyzed the current status of the site including its vision, mission, history, organizational structure, scope of services, and production line. She then identified elements of operations management and evaluated them with Balanced Scorecard assessment. Seven elements of successful long-term care operation and management were identified: environment and facility; leadership and management; customer service; infrastructure and procedure; learning and growth opportunity; finance and policy. These seven elements are holistically interrelated and offer valuable insight for long-term care providers at large. The facility highlighted in this study has hosted multiple public-private joint ventures, thus the study may have certain limitations. Moreover, Taiwan’s long-term care insurance policy, to be implemented in four years, will significantly affect the country’s long-term care management system. If the government continues to pursue healthcare reimbursement approaches based on facility/equipment set-up, personnel distribution and accreditation results, many long-term care providers will face reductions in revenue that could result in business closures. The Taiwan government should carefully study the planned long-term care insurance policy prior to its implementation to ensure financial sustainability for quality service providers, and ultimately, benefit to vulnerable elders.

Key words: long-term care； operation and management；key successful factors；Case study