臺灣博碩士論文加值系統

「病人安全」是醫療服務品質的根本，也是醫療照護者和病患間最基本的共同目標，因此提高醫療服務品質是醫院經營的首要方針，而藥事服務是醫院醫療服務首要的一個病安環節，因此如何改善台灣民眾櫃檯式匆忙領藥習慣，提昇給藥安全及滿足病患藥物相關資訊需求，一直是醫院管理者及藥事部門重視的課題。
本研究希望經由文獻回顧及專家的觀點，找出影響病患給藥服務決策時的評估因素，結合決策實驗室分析法(DEMATEL)及分析網絡程序法(ANP)，建構病患評選因果模型及評選因素間相關性及權重排序，選出藥事服務提供者決策因素分析。另一方面應用病患對藥局藥事服務的滿意度問卷調查分析，以瞭解藥局提供的藥事服務品質是否符合病患之期望與需求，並做為藥事服務品質績效評核及決策因素執行之參考。
從文獻回顧及專家訪談的結果找出影響決策時的評估因素，依其作業流程及服務屬性發展出四項因素及17項次因素DEMATEL問卷，共回收病患及專家各10份有效問卷，結果顯示，環境設施及藥品調劑服務是原因群，候藥服務及藥品諮詢服務被歸類到結果群中，其中候藥服務對藥品調劑服務有直接影響關係且重要度最高，仍應針對可以改善之項目進行處理，將未影響其他因素刪除後，將評選因素縮減為三項因素及9項次因素，並以此結果建立ANP決策模型及設計問卷發放，共回收有效問卷為病患13份及專家11份，結果顯示，關鍵選擇給藥服務品質決策主因素為藥品調劑服務及候藥服務，整體決策次因素為異常抱怨事件處理、調劑給藥的正確性、用藥適當性評估、藥袋藥品標示完整性及主動親切問候及關懷是最重要的前5項決策因素。
民眾滿意度問卷分析採用李克特(Likert)五分量表評分，共回收有效問卷為212份，回收率達96.36％。結果顯示主因素排名第一為候藥服務4.2704分，藥師諮詢服務4.2158分位居最後，次因素前五名藥局領藥服務、藥袋藥品標示完整性、親切主動關懷、候藥區的光線明亮及調劑給藥的正確性，等候領藥的時間是最低4.1792分。
透過研究方法之運用，建置了主動式給藥服務決策模型以及決策因素的重要性排序，管理者可以透過此模型得知因素之間的因果關係，並透過改善因進而達成果，此外，透過本研究結果了解病患在評估決策上的考量權重後，可以針對關鍵性的決策因素投入資源改善；滿足病患也就是消費者而提升其同儕間之競爭力。

“ The safety of Patients” is the basis of the quality of medical treatment service, which is also the basic common goal between the attendants of medical treatment and patients ; therefore, to promote the quality in medical treatment is always regarded as the top priority on the medical people’s mind. Also, medicine service is one of the most primary medical treatment services in the hospital. As a result, how to get rid of the habit of getting the medicine hurriedly from the counter for the people in Taiwan, and how to upgrade the safety of giving the medicine and satisfy the patients for the demand of related medical information, which is the most important issue that is emphasized by the administrators and medical department all the time.
This study mainly hopes that the facts of evaluation that affect the decision for the service of giving patients medicine can be found by reviewing the documentaries and through the opinions from the experts, combining DEMATEL with ANP, and builds up the model of cause and effect for the choice of patients and the relationship between the factors for the choice and the priority. In the end, we can give the people who are responsible for the service of medicine the analysis of factors for decision-making. On the other hand, the analyses of the questionnaires for the satisfaction of pharmacy medicine service from the patients are applied to understand whether the quality of medicine service provided from the pharmacy meets the expectation and demand of patients, and they also work as a reference for the evaluation of quality in medicine service and the enforcement of the factors in decision-making.
From the documentary-reviewing and the results of the interview with the experts, we are trying to find what kinds of factors are affecting the decision-making. There are 4 main factors and 17 minor factors DEMATEL questionnaires developed according to the work procedure and the category of service, and there are respective 10 valid questionnaires returned from patients and experts alike, which reveals that the environmental facilities and the arrangement of medicine are the group of causes. As for the waiting for medicine and the service of medicine consultation, they are generalized into the group of effects, especially the service of waiting for the medicine which has a direct influence on the service of the medicine arrangement and it is also the most important among them, and surely we can still deal with the items that can be improved and delete other factors that are not related to it. After that, the decisive factors will be minimized into three main factors and nine minor factors; based on the results, ANP decision model will be established and the questionnaires will also be delivered. The valid questionnaires which are received are thirteen copies from the patients and eleven copies from the experts. The results reveal that the main factors in decisive choice for the quality of giving medicine service are the services of medicine arrangement and waiting for the medicine, and the minor factors in the whole decision are the management for the unusual complaining events; what’s more, the exactness for giving and arranging medicine, the evaluation for the appropriateness of using medicine, the completeness for the indication of the medicine on the drug bag, and the greetings and care actively and kindly are the first five key factors which is thought of as the most important.
As for the analysis of satisfaction from the public, I adopted the method of Likert to analyze all the questionnaire. The valid questionnaires which are returned are 212 copies, which accounted for the percentage of 96.36 for the received rate. According to the results of the survey, the waiting for medicine is the score of 4.2704 which is placed number one in the main factors, while the service of pharmacist consultation is the score of 4.2158 which is last place in the main factors. As for the minor factors, first place is the satisfaction of the whole pharmacy followed by the service of giving the medicine, the completeness for the indication of the medicine on the drug bag, the greetings and care actively and kindly, the brightness of the light in the waiting area and the exactness for giving and arranging medicine, while the time of waiting for getting the medicine in the score is the lowest , 4.1792.
Through the exercising of research method, the decisive model for giving medicine service actively and the important priority of decision factors is built up. The administrators will be aware of the relationship of cause and effect among the factors through the model, hoping to improve the causes which lead to the inconvenience to the public and finally to reach the perfect effects. In addition, through the results getting from the study, the administrators will input the improvement of work resource for the key decisive factors after they understand the precedence over the evaluation of decision. After all, satisfying the needs of the patients, namely, consumers, and promoting the competition between the hospitals are the goals we hope to achieve。.

目錄
目錄 i
圖目錄 iii
表目錄 iv
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 3
第三節 研究流程 4
第二章 文獻探討 7
第一節 藥事服務 7
第二節 藥局服務品質與顧客滿意度 14
第三節 給藥服務品質決定因素 21
第四節 決策實驗室分析法 24
第五節 分析網絡程序法 28
第三章 模型建構方法 36
第一節 研究架構設計 36
第二節 DEMATEL模型建構 38
第三節 ANP模型架構 45
第四節 滿意調查問卷發展 49
第四章 研究結果分析與討論 53
第一節 選定評估服務準則 53
第二節 決策實驗室法結果 54
第三節 網絡程序分析法結果 78
第四節 民眾滿意度問卷調查分析結果 88
第五節 討論 92
第五章 結論 95
第一節 研究結論 95
第二節 研究貢獻 97
第三節 研究限制與後續研究建議 99
參考文獻 101
附錄一 主動式給藥服務品質DEMATEL問卷 108
附錄二 主動式給藥服務品質網路層級分析法(ANP)問卷 113
附錄三 主動式給藥服務模式滿意度調查問卷 120
附錄四 病患滿意度樣本結構表 123

圖目錄
圖1.1 研究流程 6
圖3.1 研究架構 37
圖3.2 DEMATEL主要的步驟 38
圖3.3 因果關係圖 42
圖3.4 ANP執行步驟 45
圖4.1 主要因素之因果關係圖 60
圖4.2 環境設施次因素之因果關係圖 66
圖4.3 藥品調劑服務次因素之因果關係 71
圖4.4 環境設施次因素之因果關係圖 76
圖4.5 ANP層級架構圖 79

表目錄
表2.1.門診藥局服務品質之構面總表 17
表2.2 決定因素之文獻探討整理 23
表2.3 DEMATEL運用於多準則決策分析之文獻探討整理 27
表2.4 ANP相關研究之整理 35
表3.1 DEMATEL問卷評分尺度 39
表3.2 總影響關係矩陣之行列運算 42
表3.3 給藥服務品質決定因素 43
表3.4 ANP評估尺度 46
表3.5 ANP問卷範例 46
表3.6 隨機指標 48
表3.7 主動式給藥服務模式滿意度調查之構面及其問 51
表4.1 就診民眾問卷樣本結構表 55
表4.2 專家問卷樣本結構表 55
表4.3 四個主因素總影響關係矩陣之行列運算 58
表4.4 主要因素影響關係表 59
表4.5 環境設施主因素下次要因素之總影響關係矩陣 63
表4.6 環境設施之行列運算 64
表4.7 環境設施次要因素間影響關係表 65
表4.8 藥品調劑服務主因素下次要因素之總影響關係矩陣 68
表4.9 藥品調劑服務之行列運算 69
表4.10 藥品調劑服務次要因素間影響關係表 70
表4.11 候藥服務主因素下次要因素之總影響關係矩陣 74
表4.12 候藥服務之行列運算 74
表4.13 候藥服務次要因素間影響關係表 75
表4.14 就診民眾樣本結構表環境設施之行列運 80
表4.15 藥師專家樣本結構表 80
表4.16 分群比較之ANP權重分析結果表 81
表4.17 決策因素之成對比較矩陣一致性檢定 82
表4.18 環境設施影響各因素間相互依賴關係成對比較矩陣 82
表4.19 空調下次要因素相互影響關係之成對比較矩陣 83
表4.20 未加權超級矩陣 84
表4.21 加權超級矩陣 85
表4.22 極限化超級矩 86
表4.23 ANP決策因素權重評估結果 87
表4.24 病患選擇該醫院就醫的因素樣本結構表 89
表4.25 個人特性樣本結構表 90
表4.26 病患滿意度主因素排名分析結果表 91
表4.27 ANP決策因素權重及病患滿意度排名結果分析 91

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三、網路文獻
1. 亞洲微創手術中心.
http://aits.tw/Default_e.aspx
2. 行政院衛生署
http://www.doh.gov.tw
3. 秀傳醫療財團法人彰濱秀傳紀念醫院
http://www.cbshow.org.tw/changbin/
4. 美國JCAHO（Joint Commission on Accreditation of Health Organizations）
http：//www.jcaho.org
5. 財團法人台灣醫療改革基金會 http://www.thrf.org.tw/Page_Show.asp?Page_ID=380
6. 財團法人醫院評鑑暨醫療品質策進會
http://www.ticha.org.tw