臺灣博碩士論文加值系統

近年來環境管理系統之相關建立，已成為國內醫療機構積極推動環境保護策略之一。然而許多醫療機構於執行環境管理系統之後，仍無法提出具體且有效之方式來對外展現出其在環境管理系統中所創造之環境績效。本研究之目的係以醫療院所為研究對象，參考ISO 14031環境績效評估標準建立適用於我國醫療院所之環境管理績效評等系統，並藉由專家德懷術法，研訂各類指標之權重；之後並製作醫院問卷，收集、分析及探討國內各層級醫療院所之環境管理現況與成效，期能完整呈現其績效與實際了解各醫療院所管理面及實務面需加強改善之項目，據以作為持續改善之努力方向。
依據本研究之資訊收集與德懷術專家問卷之執行，確立本研究所擬訂醫療院所環境管理績效之評等系統，共計有4個面向、82項指標，再經由醫療院所之問卷調查，配合重要-績效分析法之分析，可求得各指標之成效分數及優先改善順序。依據行政院衛生署91~95年度醫院評鑑暨教學醫院評鑑，其規模在地區醫院以上之醫療院所計有約150家，經過抽樣調查，問卷發出148份，共回收101份，回收率為68.24%，並有效運用SPSS統計套裝軟體進行描述性統計、單一樣本t檢定等統計分析方法，並依此提出建議，期能作為我國醫療院所在執行環境績效評等之參考，研究結果顯示：
1.重要-績效分析法可得知專家問卷與醫院問卷其四個面向中，整體之績效分數，專家問卷較醫院問卷為高。經統計整理得知各類指標之改善優先順序如下：【面向一實務操作面】各指標改善前三項：【紙類資源回收量】、【鐵、鋁罐資源回收量】、【病媒蚊管制指標】。【面向二技術操作面】各指標改善前三項：【廢棄物委託合格廠商之數量百分比(%)】、【實驗室廢液分類、貯存適宜性】、【實驗室廢液清除、處理適宜性】。【面向三行政管理面】各指標改善前三項：【放流水標準符合度】、【廢棄物稽查執性之次數（次/月）、違反環保法令紀錄(次/年)】。【面向四維護管理面】各指標改善前三項：【機具維護檢修之次數(次/月)】、【依據保養計畫執行完成率(%)】、【院內景觀及植栽之除草、修剪等執行率(%)】。由此可明確得知其績效與各面向中需加強改善之項目，做為持續改善之評估依據。
2.藉由環境績效評估得知全省環境績效分數平均68.93分，經過單一樣本t檢定，顯示我國醫療院所整體環境績效評估之績效尚可。
3.不同的地理區域與環境績效分數之間的差異，經單因子變異數
分析顯著水準，以東區(70.57)、北區(70.46)、南區(68.72)績效分數較高；中區(65.93)績效分數較低，檢定結果達到顯著差異水準。
4.藉由問卷分析可了解不同地域、規模及是否參與「環保醫院」之
醫療院所，在環境績效評估問卷量表中得分上具有顯著差異性；不同地域位置、醫院之規模與是否登錄為「環保醫院」之醫療院所是有其差異性，且達顯著水準。
5.藉由Person積差相關分析法顯示實務操作面向、技術操作面向、
行政管理面向與維護管理面向有顯著之正相關性。
6.經由本研究研果得知，本研究所建立之醫療院所環境績效評估指
標系統並非適合各類醫療院所，唯除法令所要求執行外，可依照各醫療院所之區域性、醫院規模與醫院政策之不同而訂定之，以利各醫院確認與執行優先改善之標的，進而朝向達成醫院環境管理之目標與方向。
關鍵詞：醫院環境管理、環境績效評估、重要-績效分析法

Abstract
In resent years, the environmental management system had been established. It is also one policy of environment protection promoted by internal medical institutes.
However, there is no specific and effective way to demonstrate the achievement of environmental management system, after execution. The purpose of our research is to build assessment system of environmental management, according to the standard of the ISO 14031. The subject is our internal medical institutes. Multiple indicator should be made according by the experience of the experts and the laws. The questionnaire should be made to collect, analyze and study the data of environmental management status and effectiveness at all levels of domestic medical institutions. We suppose to demonstrate completely performance, to show understanding of the actual management of medical institutions and to improve the practical need.
Based on collected information and questionnaire of experts, the assessment system of environmental management for the Institute of medical institutes had been established including four directions and 82 indicators. Through investigation of the questionnaire from the medical institutions and importance analysis, we can achieve the scores of all indicators and the priority of the improvements. Based on the evaluation of teaching hospitals certified by the Department of
Health of the Executive Yuan during 91 to 95, there are about 150 the regional medical institutes and medical institutes superior to regional medical institutes. After sampling, 148 questionnaires had been sent to them and 101 questionnaires had been recovered. The recovery rate was 68.24%.By effective use of SPSS statistical software, the descriptive statistics, and a single sample t-test is proceeded. The recommendations, as reference for performing the assessment system of environmental management in our medical institutions had been made as follow:
1. By the important - performance analysis, we know the overall performance scores of the expert’s questionnaire is higher than the scores of the hospital questionnaire at the four direction. After finishing statistical data, the improvement priorities are as follows:
Direction one: The first three improved indicators of practice-oriented direction: the amount of
recycling of paper, the amount of recycling of aluminium and iron cans, control indicator of
disease-mediated Mosquito.
Direction two: The first three improved indicators of the technical operations direction: the
percentage of the number of legal qualified waste processing agent(%), laboratory liquid waste
classification and storage suitability, laboratory liquid waste removal, and suitability of process.
Direction three: The first three improved indicators of administration-management direction:
suitability for the standards of the liquid discharge, the frequency of the waste inspection of time
(times / month), the frequency of violations of environmental laws (times / year).
Direction four: The first three improved indicators of the maintenance and administration direction:
the frequency of the maintenance and repair of machines (times / month), the completion rate of
the execution based on the program(%),the execution rate of the hospital landscape and the weeding
and clipping of the plant(%)].
The performance and the improved indicators of all direction are clear. It is a basis for continuous
improvement in the assessment.
2. By the assessment system of the environmental management, the average scores of performance around the province is 68.93 points. Through single sample t-test, the overall performance of environmental e assessment is fair.
3. The different geographical regions get different scores of the environmental performance. Through the ANOVA, Eastern (70.57), North (70.46), and Southern (68.72) get higher scores and Central (65.93) gets lower scores. The results reach the statistical significance.
4. By analysis of the questionnaire, we realized the statistically significant difference scores at questionnaire of environmental assessment is due to different location, different scale and whether to participate in "green hospital" or not.
5.The relation of practice-oriented direction, technology-oriented direction, and administration-management-oriented direction show significant positive correlation by person's correlation analysis.
6. The assessment system of the environmental management established by our study is not suitable for all types of medical institutes. Except required by the law, this system could be set up according to region of medical institutions, the scale of hospitals and hospital policy. It would give priority of execution and improvement of environmental management.
Key Words：Hospital Environmental Management,Establishment of Environmental
Performance,IPA

第一章 緒論
1.1 研究動機及目的..............................................2
1.2 研究範圍及內容..............................................3
第二章 文獻回顧
2.1醫療事業廢棄物……………………………………….................... 5
2.2國內醫療院所廢棄物處理概況……………………….....................8
2.3國外醫療廢棄物相關管理政策……………………......................13
2.4國內醫療院所廢水處理.........................................17
2.5 ISO 14000及環境績效評估....................................24
2.6 ISO 14000及環境績效評估....................................54
第三章 研究方法
3.1 研究架構與流程…………………………………….....................57
3.2 醫療院所環境管理之環境績效評估...............................60
3.3 資料收集及分析............................................................60
一、德懷術專家問卷之應用.........................................62
二、德懷術專家問卷之執行.........................................65
三、資料分析............................................................66
第四章 研究結果與討論
4.1德懷術專家問卷...............................................72
4.2醫療院所問卷分析.............................................89
4.3醫院問卷之推論統計分析…………………………......................121
第五章 結論
5.1結論............................................................136
5.2建議............................................................138

參考文獻.......................................................140
附件一 醫療院所適用之環境績效評估指標..............................144
附件二 德懷術專家名單............................................147
附件三 第一次德懷術專家問卷.......................................148
附件四 第二次德懷術專家問卷.......................................154
附件五 醫療院所指標問卷...........................................166

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