臺灣博碩士論文加值系統

全民健保帶動了我國醫療產業及相關就業市場的熱絡發展，如今隨著台灣邁入高齡化社會的民眾保健意識抬頭之下，原本單純的醫療服務業於是有了百花齊放多元面貌。而國民所得越高的國家，其平均每人醫療保健支出也越高。台灣在國民所得持續增加及人口結構不斷老化的趨勢下，國民醫療保健需求成長迅速，依經濟合作暨發展組織(OECD)國家的經驗顯示，國民醫療保健最終支出與國內生產毛額的比例應在一成左右，而我國目前只有6%，顯見醫療產業在無成長空間的條件下，若想永續生存則必須節樽營運成本、開創財源。
精實生產及六標準差是現今企業最常使用減少企業營運成本，近年來亦運用在服務業及醫療產業，精實生產結合六標準差成為精實六標準差(Lean Six Sigma)，則能同時消除流程間變異、減少醫療機構內部之不必要的浪費。因此本研究建議針對此議題應用精實六標準差改善之。
本研究之個案中，依循六標準差的DMAIC步驟，從顧客聲音及價值流圖析找出關鍵品質指標為降低藥品存貨成本以提高藥品存貨周轉率。搭配精實生產相關工具找出流程中非加值作業，並運用各種圖表分析等協助，及腦力激盪、標準化等方法改善醫院藥品庫房管理作業，以至於透過DMAIC改善步驟之後，得到全院672項藥品結存總金額在改善後下降2,445.57仟元，其中，A類藥品下降1,853.95仟元，且亦能達到醫院管理中心之目標，如藥品庫房之存貨周轉率需大於12次以上，可看出精實六標準差改善醫院藥品庫房存貨管理之顯著效果。

NHI has led to the development of Taiwan's medical industry and the job market to warm. Now, as under the rise of Taiwan to become an aging society, the public health awareness. Originally a simple medical services then have a flourishing multi-look. The higher the national income countries, its per capita health care spending is also higher. Taiwan's national income continued to increase and population structure of the aging trend. Rapid growth of national health care needs. According to the Economic Cooperation and Development (OECD), the country's experience has shown that the final expenditure of the National Health Service and the proportion of the gross domestic product (GDP) of a percent, while Taiwan currently only 6%. Obviously the health care industry under the conditions with no room to grow, if you want long-term survival must festival bottles operating costs, and create sources of income.
Nowadays, enterprises usually employ Lean Production and Six Sigma to cut down the business operation cos, respectively. In recent years, also used in the service industry and medical industry. Lean Six Sigma is composed of lean production and six sigma, it can eliminate the process variation, to reduce within the medical institutions of unnecessary waste.
In the research, case hospital employs the voice of customer and value stream map to find critical-to-quality target, which is lower drug inventory cost medicines in order to improve inventory turnover rate. To improve the process, we use the tool of lean production, diagram analysis, brainstorming and standardize. Then, we can improve the hospital drug warehouse management operations. Through the DMAIC steps, The total amount of the 672 drugs balances the hospital in improving a decrease of 2,445.57 thousand, Class A drugs fell to 1,853.95 thousand. And also to the hospital and Management Center goals, such as inventory turnover rate of drugs more than 12 times. We conclude that six sigma have a significant effect to improve the hospital drug warehouse inventory management.

摘 要 i
ABSTRACT ii
誌謝 iii
目錄 iv
圖目錄 vi
表目錄 vii
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究目的 3
1.4 研究架構 3
第二章 文獻探討 5
2.1 精實生產 5
2.1.1 精實生產之定義 5
2.1.2 精實生產之改善步驟及常用工具 7
2.2 六標準差 8
2.2.1 六標準差之定義 8
2.2.2 六標準差之執行步驟 9
2.2.3 六標準差常用工具 10
2.3 精實六標準差 11
2.3.1 精實生產與六標準差之差異 11
2.3.2 精實六標準差之定義 13
2.3.3 精實六標準差常用工具 14
2.3.4 精實六標準差案例 15
2.4 小結 17
第三章 應用醫院藥品存貨管理之精實六標準差 18
3.1 醫療產業 18
3.2 本研究精實六標準差之架構 21
3.3 界定階段 28
3.3.1 執行步驟 28
3.3.2 界定階段說明 28
3.4 衡量階段 29
3.4.1 執行步驟 29
3.4.2 衡量階段說明 30
3.5 分析階段 31
3.5.1 執行步驟 31
3.5.2 分析階段說明 31
3.6 改善階段 31
3.6.1 執行步驟 32
3.6.2 改善階段說明 32
3.7 控制階段 33
3.7.1 執行步驟 33
3.7.2 控制階段說明 34
第四章 個案研究 35
4.1 醫院背景介紹 35
4.2 界定階段 36
4.2.1 團隊章程 36
4.2.2 顧客聲音 38
4.2.3 價值流圖析 39
4.2.4 關鍵品質指標 41
4.3 衡量階段 43
4.3.1 流程程序圖 43
4.3.2 時間價值圖 45
4.3.3 特性要因圖 46
4.4 分析階段 49
4.4.1 現況說明 49
4.4.2 以ABC分析法分析重點A類藥品佔全院平均月支出金額之佔率 49
4.4.3在修正安全庫存日數後之A類藥品購入及結存總金額的差異分析 50
4.4.4 在修正重點A類藥品安全庫存日數後之全院藥品購入及結存總金額的差異(改善前後之藥品庫存周轉率)分析(長條圖) 51
4.5 改善階段 54
4.5.1 改善方案提出與遴選 54
4.5.2 擬定改善方案與試行計畫 57
4.5.3 改善方案試行與資料收集、指標監控 60
4.5.4 改善後之效益分析 61
4.5.5 改善方案之試行結果 63
4.5.6 改善階段之結論 63
4.6 控制階段 65
第五章 結論與未來研究方向 66
5.1 結論 66
5.2 未來研究方向 67
參考文獻 68
附錄一：個案醫院A類藥品之資料主檔試算查檢表(1) 70
附錄一：個案醫院A類藥品之資料主檔試算查檢表(2) 71

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