臺灣博碩士論文加值系統

目的：本研究以某公立醫院體系為例，應用結構方程模式(structural equation modeling, SEM)統計方法，驗證平衡計分卡所提績效指標間具有因果關係之概念模型，包括財務與非財務績效之領先與落後指標之間的因果關係。
方法：本研究採回溯性縱貫面研究，利用初級與次級資料，以醫院為分析單位，探討醫院學習與成長、內部流程、顧客、財務構面間之因果關係及影響程度。本研究以某公立醫院體系21家綜合醫院為研究對象。在初級資料方面，郵寄以結構式問卷，收集各醫院在89年至91年間，「學習與成長」構面所採行的管理活動與開始時間，及可量化且可收集之指標。次級資料則請該等醫院之主管機關提供，根據本研究選取之內部流程、顧客及財務構面之衡量指標。再以結構方程模式，分析醫院學習與成長對內部流程之影響，進而是否影響下年度顧客、財務績效。
主要發現：1.資料分析結果部分支持平衡計分卡學習與成長、內部流程(醫療品質、營運效率)、顧客、財務構面之因果關係，各構面內指標間亦有因果關係。此外，證實內部流程指標可直接影響財務構面指標，不需透過顧客構面指標作為中介變項。2.本研究證實之領先指標包括上一年目標管理之推行、TQIP之加入、每護理人員病床數、淨死亡率、平均住院日及同一年病患對醫師解答病情之滿意度。3.本研究無法證實擴大市場佔有率策略對財務為正向影響，主要因擴大市場佔有率會負向影響病患滿意度。4.利用89年對90年資料、以及90年對91年資料分析的結果，發現兩組資料納入模式的學習與成長指標不同，反映出管理模式是一動態模式，隨者時間的不同，應該調整平衡計分卡內的領先指標。
結論：本研究利用結構方程模式，驗證平衡計分卡各績效構面指標間之因果關係，證實領先指標之績效會影響下一年落後指標之績效。醫院經營管理者可參考本研究結果，管理領先指標之績效，以創造組織未來價值。然由於管理環境是一動態體系，故領先與落後指標之間因果關係必須定期確認，並調整模式內的指標。

Objective: The objective of this study was to use a public hospital system as an example to examine causal relations among performance indicators in the balanced scorecard (BSC) framework by way of structural equation modeling (SEM). Indicators studied include leading and lagging indicators of non-financial and financial performance.
Methods: This was a retrospective and longitudinal study combing primary and secondary data to explore causal relations and the magnitude of impact among four perspectives of indicators. Those four perspectives were hospital’s learning and growth, internal process, customer, and financial perspectives. The unit of analysis was the hospital. Data was collected from 21 general hospitals in a public hospital system for the 3-year period, 2000-2002. For primary data, a structured questionnaire was mailed to chief executive officers of study hospitals. There are two major parts of it: whether and when hospitals adopted any management activities, and quantifiable and collectable indicators for the learning and growth perspective. Secondary data was provided by the superior institution according to indicators selected for the internal process, customer, and financial perspectives. SEM was used to explore the influence of hospital’s learning and growth on its internal process in the same year, and on its customer and financial performance in the following year.
Results: 1. The results of this study provided partial support for the claim that the BSC model reflects cause and effect relations among learning and growth, internal process (medical quality, and operational efficiency), customer, and financial perspectives. We also verified the relations among indicators within perspectives. It also proved that indicators of the internal process perspective have a direct effect on indicators of the financial perspective without using customer perspective as a mediating variable. 2. The leading indicators verified by this study included the implementation of management by objective, the initiation into Taiwan quality indicator project, total number of beds per nurse, net mortality rate, average length of stay in the last year, and patient satisfaction with physicians'' answers to patients'' condition in the current year. 3. This study fails to prove a positive and significant effect of market share on profitability, mainly because it had a negative and significant effect on patient satisfaction. 4. The indicators of learning and growth perspective with data from 2000 to 2001 and from 2001 to 2001 were different. This showed that management model is a dynamic model, thus indicators should be modified as time varies.
Conclusion: By using SEM to examine causal relations among performance indicators in the BSC framework, this study confirmed that leading indicators in the current year had positive influence on lagging indicators in the following year. Hospital administrators can apply the results of study to manage the leading indicators is to create organizations’ future value. However, the causal relations between the leading indicators and the lagging indicators must be regularly validated because management environment is a dynamic system.

致 謝 I
摘 要 II
Abstract III
目 錄 V
表目錄 VII
圖目錄 IX
第一章 緒論 1
第一章 研究背景與動機 1
第二節 研究目的與研究問題 3
第三節 研究重要性 5
第二章 文獻探討 6
第一節 績效評估之發展趨勢 6
第二節 平衡計分卡於健康照護產業之研究 13
第三節 判定因果關係之方法學 30
第四節 各構面間因果關係之實證研究 44
第五節 KANJI’S企業計分卡之貢獻 49
第六節 綜合評論 52
第三章 研究方法 53
第一節 研究架構與研究設計 53
第二節 研究假說 54
第三節 變項操作型定義 57
第四節 研究對象與資料來源 61
第五節 資料分析方法 63
第四章 研究結果 64
第一節 研究醫院基本特性 64
第二節 衡量指標之信效度分析 66
第三節 衡量變項之描述性分析 75
第四節 衡量變項間之雙變項分析 82
第五節 影響財務績效之迴歸分析 122
第六節 整體模式分析 129
第五章 討論 137
第一節 資料品質 137
第二節 分析方法之比較 139
第三節 各構面內指標間之關係 139
第四節 研究假說之討論 141
第五節 各年整體模式之比較 146
第六節 研究限制 147
第六章 結論與建議 149
第一節 結論 149
第二節 建議 150
參考文獻 152
附 錄 161
附錄一 訪談大綱 161
附錄二 學習與成長指標現況調查表 162

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