臺灣博碩士論文加值系統

人口老化已成為世界性的現象，老化造成的失能，須仰賴他人照顧，家庭婦女就業人口的成長，造成家庭的主要照顧者缺乏，需仰賴其他資源，如護理之家照顧，這些機構的工作人員中照顧服務員佔大多數；健保總額支付制度實施，醫院管理者為了要兼顧病患照護的品質以及面對營運收入減少的難題，因而將照顧服務員此非主流部分的人力派遣業務，委託外部包商來解決，期能降低成本與提升生產力。本文運用專家的群體決策以修正式德菲法技術選定適用於醫療機構在照顧服務員委外選擇外包商的一系列關鍵評選準則，接著應用網路程序分析法設定評選準則之客觀權重，並計算與排列最佳的照顧服務員外包商，研究結果發現評估模式之主準則權重最高為服務品質，其次為配合度，第三為管理能力，第四為履約經驗。期望本模式能提供台灣醫療機構，一套客觀、有效的方式來選擇最佳的照顧服務員外包商。

A rapidly growing elderly population poses a major challenge for long-term care management. For instance, with an increasing disabled elderly population, immediate solutions must be developed for assisted living of this population sector given changing family structures, a lack of caregiver in the family and the frequency of chronic illnesses. Disabled or chronically ill elderly individuals are often sent to residential nursing homes staffed by nursing care attendants in hospital subsidized facilities such as respiratory care centers and wards. Given changes in Taiwan’s National Health Insurance scheme, controlling personnel costs while maintaining highly quality services in order to maintain or increase hospital revenues is of priority concern. An effective means of doing so is to outsource nursing care attendants in such facilities to effectively control personnel costs and maintain the quality of medical services. However, hospital administrators lack an effective means of evaluating the most qualified outsourcing agency efficiently. Therefore, this work presents an ANP method to assess objectively the quality of outsourcing agencies of nursing care attendants as a viable alternative to decision-making approaches based on subjective evaluations. Criteria for outsourcing vendors and sub-criteria of nursing care attendants for medical are then evaluated using the Delphi technique. Moreover, results of interviews with experts are integrated with the ANP theory is applied to determine the objective weight values. Additionally, ANP theory is applied to calculate and rank the best efficiency in the nursing care attendants vendor model. The proposed can provide medical administrators with a decision-making and evaluation criteria to actively encourage the medical sector to outsource its needs for nursing care attendants.

摘要....……………………………………………………………………………I
Abstract…………………………………………………………………………II
目錄………………………………………………………………….........III
圖目錄………………………………………………………………………...….V
表目錄………………………………………………………………………...…VI
第一章 緒 論………………………………………………………………......1
1.1研究背景與動機…………………………………………………….....1
1.2研究問題與目的…………………………………………………….…..2
1.3研究對象與範圍…………………………………………………….....3
1.4研究流程.............................................4
1.5論文結構……………………...............................5
第二章 文獻探討………….......................................6
2.1 醫療外包管理相關探討……………………………………………....6
2.1.1台灣醫療產業的演進…………………………………………...6
2.1.2醫院採用外包經營的介紹……………………………………..10
2.2 醫院產業照顧服務員的介紹………………………………….........11
2.2.1照顧服務員的訓練……………………………………………12
2.2.2照顧服務員的需求……………………………………………15
2.3 照顧服務員外包商評選的考量因素………………………….........16
2.4 供應商的評選方式………………………………………………….20
第三章 研究方法……………………………………………………………..22
3.1 層級分析法(analytic hierarchy process; AHP)……………………...22
3.2 網路程序分析法(analytic network process; ANP)………………….24
3.2.1 ANP的特性…………………………………………………...24
3.2.2 ANP的假設…………………………………………………...26
3.2.3 ANP與AHP的相異點……………………………………….27
3.2.4 ANP的決策程序……………………………………………..28
3.3 群體決策………………………………………………………..….32
3.3.1德菲法(Delphi technique)…………………………………...33
第四章 評選模式之建立與應用……………………………………………..36
4.1第一階段：透過修正式德菲法，找出評選準則…………………..36
4.2第二階段：應用ANP決定照顧服務員外包商評選準則之權重…37
第五章 結論…………………………………………………………………..46
5.1研究結果……………………………………………………………..46
5.2 研究限制…………………………………………………………….47
5.3 後續研究建議……………………………………………………….47
參考文獻………………………………………………………………………49
附錄（一）：ANP問卷……………………………………………………….54
附錄（二）各次準則要素間相互依賴關係之綜合成對比較矩陣…………68









圖目錄
頁次
圖1-1：研究流程圖……………………………………………………………4
圖3-1：ANP的相互依賴關係狀況……………………………………………25
圖3-2：超級矩陣………………………………………………………………25
圖4-1：ANP評選照顧服務員外包商層级架 ………………………………37
























表目錄
頁次
表2-1：台閩地區各類長期照護資源分佈一覽表……………………………16
表2-2：照顧服務員外包商評選的考量因素………………………………..19
表2-3：供應商的評選方法…………………………………………………..20
表3-1：ANP與AHP的相異點………………………………………………28
表3-2：應用ANP的研究與內容………………………………… …………31
表4-1：各主準則之綜合成對比較矩陣………………………………………38
表4-2：次準則之綜合成對比較矩陣…………………………………………38
表4-3：考量各主準則要素間相互依賴關係之綜合成對比較矩陣…………39
表4-4：考量各次準則要素間相互依賴關係之綜合成對比較矩陣…………40
表4-5：未加權超矩陣…………………………………………………………41
表4-6：加權後超矩陣…………………………………………………………42
表4-7：極限化超矩陣…………………………………………………………43
表4-8：各方案之權重、得分數及排名………………………………………44

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