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研究生:陳雪芬
研究生(外文):Hsueh-Fen Chen
論文名稱:平衡計分卡績效管理制度成效評估研究—以大型教學醫院為例
論文名稱(外文):An Assessment study on the effectiveness of the Balanced Scorecard performance management system: The Case of a Medical Center
指導教授:張睿詒張睿詒引用關係
指導教授(外文):Ray-E Chang
口試委員:張怡秋蘇喜譚醒朝林妍如
口試日期:2013-01-31
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:中文
論文頁數:120
中文關鍵詞:平衡計分卡績效管理教學醫院
外文關鍵詞:balanced scorecardperformance managementteaching hospital
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研究目的:
本研究以案例醫院,某醫學中心實施平衡計分卡資訊系統的每月實際資料,對醫院平衡計分卡績效管理制度的成效進行研究評估。透過驗證性因素分析(confirmatory factor analysis, CFA)來驗證平衡計分卡四個構面,與實施平衡計分卡後對整個醫院績效的影響,且考量指標間之遞延效果,分析各項構面影響的延遲情形,並利用系統中的紅燈警示提醒,來探討平衡計分卡的警示系統的紅燈追蹤對於績效改善的影響,並進一步瞭解影響醫院績效指標改善的因素為何。
研究方法:
本研究採回溯性追蹤研究(retrospective follow-up study),研究對象為引進平衡計分卡系統之某醫學中心第一線醫療部科,屬於次級資料分析。本研究共包含兩個研究主題,第一個主題是驗證平衡計分卡各構面間以及指標間之相關性,首先探討控制不同科別特性後,各項關鍵績效指標的效度,以及指標在該構面之代表性;其次,控制醫院服務量與投入之醫師人力後,透過結構方程模式(SEM)與驗證性因素分析(CFA),探討平衡計分卡四個構面間的因果結構;第二個主題是探討平衡計分卡的實施是否有助於醫院經營績效的改善,在控制科別特性、時間趨勢等變數後,採混合線性模式進行分析,以瞭解平衡計分卡系統導入後,其紅燈警示作用對各醫療科部經營績效改善之狀況。
研究結果:
首先,關鍵績效指標(KPIs)的確定:本研究共找出七個策略目標下的19個關鍵績效指標(KPIs),除了內部流程構面的資源整合策略目標下三個指標不盡理想之外,其他16個指標證實都是關鍵績效指標(KPIs)。其次,平衡計分卡各構面間之關係:本研究結果顯示,學習與成長構面中的研究發展,對其他構面的策略目標的關係是:對內部流程構面的醫療品質為負向連結關係,與資源整合為顯著正向連結關係,對財務構面的成本控制與經營效率為正向連結關係,且具有顯著效果。第三,紅燈警示系統對醫院經營績效之影響:紅燈警示系統對成本控管、行政管理方面、住院績效等的效果較大,對照護品質類的指標警示效果較差。
結論與建議:
平衡計分卡資訊系統對醫院績效管理制度的幫助是有效的,尤其醫院是資訊多元且不易管理的地方,如何建構一個使用起來不複雜,但重要資訊不會遺漏的績效管理制度就十分重要,平衡計分卡的理念架構符合醫院關鍵績效指標的建置,且能迅速發揮其管理功能,建議醫院管理者能將其導入績效管理系統中。

Objective: In this study, the actual monthly data produced by the case hospital, a medical center implementing the Balanced Scorecard Information Systems, was used to assess the effectiveness of the Hospital Balanced Scorecard Performance Management System. A Confirmatory Factor Analysis (CFA) was conducted to verify the four perspectives of the Balanced Scorecard and the impact on the performance of the entire hospital with the implementation of Balanced Scorecard, with respect to the deferred effect between the indicators and the analysis of delay conditions resulting from the influence of various perspectives. In addition, the use of red light warning system alerts help explore the effect of Red Light tracking warning system on the performance improvement of the Balance Scorecard. As a result, it enables us to learn more about what factors could affect the improvement of hospital performance indicators.

Methods: This study was a retrospective follow-up study. The object of study is the first-line medical departments in a medical center. The research method is a secondary data analysis. The study consists of two research themes.
1) The first theme is to verify the correlation between the perspectives of the Balanced Scorecard and the correlation between the indicators. First, is to investigate the validity of the key indicators after exploring the control of various characteristics, as well as the representation of the indicators in each of the perspectives; Secondly, after applying the control of hospital service volumes and the involvement of physician manpower through structural equation modeling (SEM) and Confirmatory Factor Analysis (CFA), the study explores the causal structure between the four perspectives of Balanced Scorecard.
2) The second theme is to explore whether the implementation of the Balanced Scorecard helps hospitals improve operating performance. A mixed linear model was adopted for the analysis, after applying the control department characteristics and time trend variables, to understand the effect of its Red Light Warning Alerts on performance improvement of various medical departments after the introduction of the Balanced Scorecard system.

Results: First, validation of key performance indicators (KPIs): 19 key performance indicators (KPIs) were identified in the seven strategic goals. With the exception that three indicators relative to integration of resources in the internal processes, were not ideal, the other 16 were confirmed as valid key performance indicators. Second, the relationship between the Balanced Scorecard Perspectives: The results of this study showed the correlation of Research and Development (R&D) in the Learning and Growth perspective with relation to the strategic objectives of the other perspectives. It has a negative relative with Quality of Medical Care of the internal processes, it has a significant positive relative with the Integration of Resources, and it has positive relative with Cost Control and Operating Efficiency of the financial perspective with significant effect. The third, the Red Light Warning System for hospital operating performance: The Red Light Warning System has larger effect on cost control, administrative, inpatient performance and less effect on care indicators.

Conclusions and recommendations: Balanced Scorecard Information System provides effective help on hospital performance management, especially because hospital information is diverse and difficult to manage. It is important to know how to construct a Performance Management system that is easy to use without loss of important information.Balanced Scorecard concept structure fits in with the establishment of the hospital key performance indicators (KPIs), and can quickly play its management functions. It is recommended that hospital administrators can introduce it to the hospital management system.

第一章 緒 論 1
第一節 研究背景與動機 1
第二節 研究目的 8
第三節 研究重要性 8
第二章 文獻探討 9
第一節 績效管理的內涵與相關研究發展 9
第二節 平衡計分卡的發展沿革 20
第三節 平衡計分卡在醫療領域的應用與研究 33
第四節 案例醫院 41
第三章 研究設計與實施 45
第一節 研究設計與架構 45
第二節 研究假設 48
第三節 資料來源與研究對象 49
第四節 變項操作型定義 50
第五節 資料處理與統計分析 53
第四章 研究結果 56
第一節 關鍵績效指標(KPIs) 56
第二節 紅燈警示系統之線性混合迴歸分析 76
第五章 討論與建議 83
第一節 研究方法上的突破 83
第二節 資料品質 85
第三節 重要研究發現 87
第四節 研究假設討論 91
第五節 研究限制 95
第六節 建議 97
參考文獻 100
附錄1:個案醫院策略地圖 113
附錄2:指標名稱與操作型定義一覽表 114

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