臺灣博碩士論文加值系統

面臨醫療產業中日趨激烈的競爭環境，促使醫療機構必須設法提昇己身之競爭優勢，而品質與成本是企業最基礎與核心的競爭項目，因此如何追求高品質與低成本實乃醫療機構相當重要的課題。失效模式與效應分析(Failure Mode and Effect Analysis, FMEA)是一系統化的風險管理工具，其有助於醫療機構提昇醫療品質。品質成本是幫助量化品質的指標，醫療機構可透過衡量與降低其品質成本，提昇卓越的品質。綜上所述，探討FMEA與品質成本如何應用於醫療機構實為相當重要的議題。
回顧近年相關研究，探究如何將FMEA與品質成本應用於醫療機構之研究較少被深入地討論。故，本研究透過文獻探討建立醫療機構之品質成本項目，並逐一發展計算方式，以建構適用於醫療機構之品質成本模式。其後將品質成本的概念融入FMEA，加以發展出一整合性的FMEA推行架構。在模式與架構分析的部分，首先將估計的參數代入本研究之模式，可求出醫療機構的品質成本，而以案例的資料代入研究之推行架構，可望降低醫療機構之品質成本。
本研究認為醫療機構可參考彙整出的品質成本項目，將未考量的項目加以納入，並發展衡量方式，以完善成本體系。此外，醫療機構亦可參考本研究之品質成本模式，計算其品質成本，並針對重點項目加以改善。而組織可參考本研究之整合性的FMEA推行架構，運用系統化的方式降低品質成本。還有，組織推行FMEA時，可將品質成本納入考量，以其輔助RPN值，俾能彌補傳統FMEA之不足。本研究亦綜合考量RPN值與品質成本，依據可能出現的情況，發展相應的對策，可供組織參考。本研究結論認為，FMEA與品質成本皆為預防性的工具，若能將兩者加以整合，可用FMEA的系統化方式降低品質成本，並以品質成本輔助衡量失效模式與FMEA的改善成效，二者相輔相成，應可獲更大的綜效。研究僅考量醫療機構及一般線性模式的品質成本，未來亦可將醫療產業的外部特性因素與不確定性納入研究方向。

In the highly competitive environment, it is critical for healthcare institutions to enhance competitiveness. Quality and cost are the most fundamental and core concepts of the enterprises’ competitiveness. Therefore, it is important for healthcare institutions to pursue higher quality and lower cost. Failure Mode and Effect Analysis (FMEA) is a systematic risk management tool and it is effective to improve the quality of healthcare. The concept of quality costs is a means to quantify the total cost of quality-related efforts and deficiencies. Through proper analysis and management of quality costs, healthcare institutions can actually improve on outstanding healthcare quality. Therefore, it becomes absolutely important to explore how FMEA and Quality Costs can be effectively applied in healthcare institutions
Application of FMEA and quality cost in healthcare institutions is a neglected aspect in existing studies. Therefore, this research develops a Quality Cost Model for healthcare institutions through developing cost calculation methods based on issues regarding quality costs of healthcare institutions in related references. In addition, the concept of quality costs is included into FMEA to develop an integrated FMEA implementation structure. In the perspectives of model structure analysis, estimated variables are entered into the proposed model and quality costs of the healthcare institutions are calculated. Then, the case data are entered into the proposed model, and it is expected to find out how the quality costs can be reduced through FMEA.
This research points out that healthcare institutions can include unconsidered quality cost items into the current system to improve on the quality. Besides, healthcare institutions can consider the proposed model of this research to calculate their quality costs and to improve further on their current system. Furthermore, organizations can consider the proposed integrated FMEA structure to reduce quality costs systematically. When organizations implement FMEA, quality costs can be considered to support RPN score and to improve on the traditional FMEA methodology. In this research, RPN score and quality costs are considered to develop methods of how the organizations can deal with possible undesirable outcomes. Conclusion of this research regards both FMEA and quality costs as preventive tools that can be integrated to reduce quality costs systematically as well as to improve the overall performance of quality management. However, this research is limited to healthcare institutions and linear model. Perhaps, external characteristics of the healthcare industry and uncertainty can be included in future studies.

摘要 I
ABSTRACT II
誌謝 IV
目錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究範圍與限制 2
第四節 研究架構與流程 2
第五節 論文架構 4
第二章 文獻探討 5
第一節 醫療產業 5
第二節 品質成本 10
第三節 失效模式與效應分析(FMEA) 18
第三章 研究方法 30
第一節 醫療機構品質成本模式 30
第二節 推行架構 42
第四章 模式與架構分析 47
第一節 模式之數值範例 47
第二節 品質成本結構分析 54
第三節 案例之推行架構 58
第四節 RPN值與品質成本 67
第五章 結論與建議 69
第一節 研究結論 69
第二節 未來研究方向與建議 71
參考文獻 72
附錄一 FMEA實施手冊第四版重點摘錄 80

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網站部分
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