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研究生:林怡婷
研究生(外文):Yi-Ting Lin
論文名稱:以作業管理觀點探討急診醫療服務品質
論文名稱(外文):A Study on Emergency Department Service Quality from the Viewpoint of Operational Management
指導教授:黃崇興黃崇興引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:商學研究所
學門:商業及管理學門
學類:一般商業學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:60
中文關鍵詞:急診滿意度等候時間環境設施作業流程空間配置
外文關鍵詞:Emergency satisfactionWaiting timeEnvironment/facilityOperation processEnvironmental arrangement
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隨著急診病患就診人數的逐年增加,急診部不僅被視為醫院對外的最前線戰力,於醫療體系的重要性也一再提升。尤其在大型且有名聲的醫院急診部,到處可見人滿為患之景象;在病患及家屬願意來此就診,顯示出其備受肯定之餘,加深急診部管理上的困難,引起病患及家屬就診過程中的不便,進而造成急診部、甚至醫院整體滿意度的大幅下滑。

本研究以國立臺灣大學醫學院附設醫院急診部為探討對象,由民國96年及97年現行滿意度調查,得知滿意度最低項目為「等候時間」與「環境設施」,彙整為急診目前面臨問題─「作業流程」與「空間配置」問題。續而透過國內外初步文獻回顧,整理出病患及家屬對急診醫療期待之要素,進行問卷調查,調查現場病患及家屬對四項關鍵要素重要性分析,結果顯示「等候時間」與「環境設施」重要性排序相對較低,反應出目前必須改善者為重要性相對較低之問題。

了解其相對重要性後,藉由服務流程與環境之系列分析,輔以相關數
據資料,找出「作業流程」與「空間配置」問題根源。「作業流程」方面,檢視臺大醫院急診作業流程,發現相較其他醫院急診部,「等待看診」時間相對較長,屬不正常之現象。然臺大醫院病患人次與其他醫院一般,甚至相對較少,但由於臺大醫院急診觀察床貢獻率與專任醫師生產力偏低,每位病患滯留於急診部時間拉長,造成「等待看診」時間較長。

「空間配置」方面,「服務環境分析」中探討各醫院之週遭環境、空間/功能、與標誌、符號及人工裝飾等對病患、家屬、及醫事人員可能產生之影響,發覺臺大醫院呈現較吵雜、照明偏昏黃、門廳被空床與暫留病床佔滿、病患隱私較差、座椅不足等環境氛圍。其根源原因除空間設計因素外,由於流程內部之資產與人員作業效率偏低,使病患滯留於急診部時間較長,呈現出較擁擠、吵雜、無隱私之環境氛圍。

為根除上述問題根源─內部資產與人員效率不彰、空間設計不良,建議臺大醫院強化界面管理,以改善急診暫留狀況並提升作業效率;擴大急診部空間並重新配置,提升正面感受;同時進行硬體與軟體改造,提高等候時間之滿意度。
With the increasing number of patients at Emergency Department (ED), not only is ED being regarded as the battlefront of hospital as a whole, the ever-rising significance of EDs in the medical system can also be observed. Especially for EDs in large and renowned hospitals, over-crowdedness occurs all the time. While the impressive records of those EDs are assured by the overwhelming number of patients, difficulties concerning the overall management are augmented, more inconvenience are experienced by patients and their families, and as a result, satisfaction towards the hospitals as well as the EDs drop dramatically.

The study was based on our research target, Emergency Department in National Taiwan University Hospital (NTUH). From the satisfaction survey in 2007 and 2008, it can be concluded that “Waiting time” and “Environment/Facility” were the items with lowest satisfaction, and the problems currently faced by ED in NTUH could in turn be consolidated into 2 factors, “Operation process” and “Environmental arrangement”. Followed by an on-site survey conducted in order to reveal the priority of expectation elements for EDs sorted out from literature reviews, the result showed that “Waiting time” as well as “Environment/facility” were of relatively low priorities, reflecting the fact that the problems NTUH needs to deal with now are those in lower level of importance.

In order to understand the root causes of “Operation process” and “Environmental arrangement” factors, a series of research on service process and environmental dimensions were conducted following the result of relative importance. Regarding “Operation process” factor, after a thorough diagnosis by the tool of Flowchart and Process chart, “Waiting time for doctors” was found to be longer than other sample EDs, thus categorized as the abnormal condition. And the subsequent root causes for that were analyzed to be the low contribution rate of emergency observation beds as well as the low productivity of doctors in EDs, despite the fact that absolute number of patients for NTUH was equal to or even less than others, resulting in longer stay for each patient in EDs, thus longer average wait for doctors.

As to “Environmental Arrangement” factor, a research was conducted to analyze the possible influences of ambient conditions, space/function, and signs, symbols, & artifacts, on patients, families, and employees in each of the sample EDs. Result showed that ED in NTUH elicits unpleasant feelings from noisiness, dim lighting, lobby occupied with observation beds, lack of privacy, not enough chairs, and etc. Probing the root causes revealed that on top of the environmental design factor, lack of asset and employee efficiency lengthened patents’ average stay in EDs, thus creating negative impressions.

Some suggestions raised to eradicate above root causes, “Lack of asset and employee efficiency” and “Inferior facility design”, were reinforcement of interface management to improve observation condition in EDs and promote operation efficiency, site expansion and rearrangement of EDs to enhance patients’ pleasant feelings, and lastly, reconstruction of hardware and software to raise the satisfaction of inevitable waits.
口試委員會審定書………………………………………………………………………i
謝辭……………………………………………………………………………………ii
中文摘要……………………………………………………………………………iii
英文摘要………………………………………………………………………………iv
第一章 緒論…………………………………………………………………………1
第一節 研究動機…………………………………………………………………1
第二節 研究對象與時間………………………………………………………2
第三節 研究設計…………………………………………………………………2
第四節 研究流程架構……………………………………………………………4
第二章 文獻探討……………………………………………………………………5
第一節 急診病患就醫的考量因素………………………………………………5
第二節 影響病患滿意度之構面…………………………………………………6
第三節 醫療服務品質指標………………………………………………………7
第四節 文獻探討總結……………………………………………………………8
第三章 現行滿意度調查分析………………………………………………………9
第一節 研究方法─現行滿意度調查分析………………………………………9
第二節 民國96年第二次(3月至11月)急診病人滿意度調查結果…………9
第三節 民國97年第一次(3月至6月)急診病人滿意度調查結果…………12
第四節 小結─現行滿意度調查分析…………………………………………14
第四章 服務關鍵要素重要性分析………………………………………………15
第一節 研究方法─服務關鍵要素重要性分析………………………………15
第二節 研究結果─服務關鍵要素重要性分析………………………………19
第三節 小結─服務關鍵要素重要性分析……………………………………22
第五章 服務現場流程與環境分析………………………………………………23
第一節 服務現場流程分析………………………………………………23
第二節 服務現場環境分析………………………………………………32
第六章 結論與建議………………………………………………………………37
第一節 急診表面問題整理暨歸類………………………………………37
第二節 問題根源之探討分析………………………………………………37
第三節 改善建議……………………………………………………………40
第四節 後續研究……………………………………………………………42

參考文獻………………………………………………………………………………44
附錄一 臺大醫院急診病人滿意度調查問卷(民國97年最新修訂版)……………46
附錄二 服務關鍵要素重要性分析調查問卷 版本一………………………………48
附錄三 服務關鍵要素重要性分析調查問卷 版本二………………………………54
附錄四 「急診觀察床使用率」之詳細原始數據……………………………………60
附錄五 「急診專任醫師生產力」之詳細原始數據…………………………………60
中文
1.張采琨:醫院醫療服務品質指標認知差距之實證研究,國立政治大學會計研究所碩士論文 (1996)
2.張貽晴:急診醫療服務品質衡量模式之研究,國立成功大學工業管理研究所碩士論文 (1999)
3.黃慧娜:急診服務與病人滿意度調查研究,國立臺灣大學公共衛生研究所碩士論文 (1993)
4.謝忠和:運用模擬於急診作業流程之改善;45-47 (1998)
5.蔡哲宏:急診病人選擇醫院之考慮因素探討及行銷研究─以台北市八家醫院為例,國立陽明大學醫務管理研究所碩士論文 (1996)
6.王乃弘,黃松共:民眾對選擇醫院因素及態度之研究─以中部數家醫院為例;29(2):1-15 (1996)
7.王俊文,葉德豐,曾坤儀:台灣醫院評鑑趨勢的探討,Chung Shan Med J;14:511-522 (2003)
8.閻守鈞:急診醫療品質改善計畫實施成效評估,國防公共衛生研究所碩士論文 (1999)
9.顏月珠:高階統計方法;883-886 (1994)

英文
1.Bailey A., Hallam K., Hurst K.: “Nursing practice. Triage on Trial”, Nursing Times; Nov 4-10, 83(44): 65-6 (1987)
2.Bjorvell H., Steig J.: “Patients’ perceptions of the health care received in an emergency department”, Annals of Emergency Medicine; 20: 734-738 (1991)
3.Bursch B., Bezzy J, Shae R.: “Emergency department satisfaction: What matters most?”, Annals of Emergency Medicine; 22: 586-591 (1993)
4.David H. Maister: “The Psychology of Waiting Lines”, Managing Services; 176-183 (1988)
5.Gill J. M.: “Nonurgent Use of the Emergency Department: Appropriate or Not”, Annals of Emergency Medicine; 24(5): 953-7 (1994)
6.Institute of Medicine: “Crossing the Quality Chasm: A New Health System for the 21st Century”, National Academy Pr; 3 (2001)
7.Krishel S., Baraff L. J.: “Effect of emergency department information on patient satisfaction”, Annals of Emergency Medicine; 24: 1092-1096 (1994)
8.Kurata J. H., Watanabe Y., McBride C., Kawai K., Andersen R.: “A comparative study of patient satisfaction with health care in Japan and the United States” (1994)
9.Mary Jo Bitner: “Servicescapes: The Impact of Physical Surroundings on Customers and Employees”, Journals of Marketing; 56: 60 (1992)
10.McMillan J. R., Younger M. S., DeWine L. C.: “Satisfaction With Hospital Emergency Department As a function of patient triage”, Health Care Management Review; 38-40 (1986)
11.Shesser R., Kirsch T., Smith J.: “et al, An Analysis of Emergency Department Use by Patients with a Minor Illness”, Annuals of Emergency Medicine; 20: 743-8 (1991)
12.Tarlov A.R., Ware J.E.: “An application of methods for monitoring the results of medical care”, JAMA; 18(7): 925-930 (1989)
13.Thompson D. A., Yarnold P. R., Williams D. R., Adams S. L.: “Effects of Actual waiting time, Perceived waiting time, Information delivery, and Expressive quality on Patient satisfaction in the Emergency Department”, Annals of Emergency Medicine; 28(6): 657-665 (1996)
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