臺灣博碩士論文加值系統

全民健保實施後民眾就醫性更方便了，也使得醫院門診量逐步上升，使得醫院須提供更多醫療設備作診斷及治療，且加重醫療工作人員的負擔，進而造成病人的等候時間增加，實際看診時間卻縮短之情形發生。本研究以專家學者的文獻佐證及3間國內醫院之門診流程作為基礎，彙整出門診等候時間之因素。並在KJ法的使用下，建立影響等侯時間架構雛形，再透過在焦點團體訪談與德爾菲等方法下，進行架構出各類別之合理且適切性檢測，完成影響門診等候架構終案。最後，在層級分析法(AHP)下，使本研究對於門診等候時間因素架構能夠建立出程度上的差異。
本研究發現影響門診等候因素以「醫師診間內做處置」、「診斷病情與解釋檢查報告過久」、「未能主動告知相關知識，引起病人擔憂與不必要詢問」、「醫師與病人雙向溝通不佳」、「疾病輕重導致看診時間落差」、「不清楚報到規則」、「等待檢驗報告」及「各科室之間的協調不足」等八個項目所佔權重較高，主要都與看診構面有關，可見病人就醫過程中最常在「看診過程」中等候最久。相信院方主管若能參照本研究成果，且予以支持改善，投入更多的資訊服務及足夠的人員配置，達到以「病人為中心」之優質就醫環境，將成為病人信賴之醫院；同時，也能藉此研究期能做為醫院管理者對服務品質提升之參考。

After the implementation of the national health insurance system, more patients seek medical service. The increased number of outpatients resulted in longer waiting time for patients, shortening the time of interaction between doctors and patients, and higher workload for the medical staffs. This study was aim to analyze the key factors associated with outpatients waiting time.This research study was conducted using information and data collected from three hospitals and literature review. We used Kawakita Jiro (KJ) technique to identify the key factors related to the waiting time of outpatients. Focus group method and Delphi method were used to check the accuracy of these factors. Analytic Hierarchy Process (AHP) was used to prioritize these factors.
From the information and data of the three hospitals we studied, eight conditions were identified that led to prolonged outpatients waiting time. First, doctors performed intervention for outpatients during the same visit. Second, doctors spent much time to diagnose and explain the examination reports to patients. Third, doctors did not have enough time to perform disease teaching that resulted in patients’ worries and asked more questions. Fourth, patients and doctors had poor communication. Fifth, difference of the diseases severity of patients had impact on their visit time. Sixth, patients did not realized the registration and check in processes. Seventh, patients had to wait for the results of examination in the same visit. Eighth, different departments of hospital did not have good cooperation. By modifying the visiting and examination processes for outpatients and establishing doctor-patient relationship, we hope to reduce the waiting time for outpatients. Suggestions for the hospital administrators were made based on the findings to improve the service quality of waiting time on outparient department. At the same time, it can be able to provide better “patient-centered” health care service.

摘要...................................................I
ABSTRACT..............................................II
誌謝...................................................IV
目錄...................................................V
表目錄.................................................VIII
圖目錄.................................................IX
第一章 緒論...............................................1
1.1 研究背景............................................. 1
1.2 研究動機............................................. 2
1.3 研究目的............................................. 3
1.4 研究流程............................................. 4
第二章 文獻探討......................................... 7
2.1 個案醫院門診－T醫院................................... 7
2.2 個案醫院門診流程...................................... 9
2.3 門診掛號............................................. 13
2.3.1初診掛號............................................ 13
2.3.2複診掛號............................................ 13
2.3.3預約掛號............................................ 14
2.4 門診服務品質......................................... 15
2.4.1服務品質模式........................................ 16
2.4.2服務品質衡量方式..................................... 17
2.5 門診服務............................................. 18
2.6 門診環境............................................. 20
2.7 門診等候時間......................................... 20
2.7.1看診排程規則........................................ 20
2.7.2等候時間內涵........................................ 21
2.7.3等候心理因素........................................ 22
2.8 研究方法............................................. 22
2.8.1 KJ法.............................................. 22
2.8.2焦點團體訪談法（Focus Group Interviews）............. 23
2.8.3德爾菲法（Delphi Method）........................... 25
2.8.4層級分析法（Analytic Hierarchy Process, AHP）........ 25
第三章 研究架構與方法.................................... 30
3.1 門診流程合併......................................... 30
3.1.1彙整門診流程之架構................................... 30
3.1.2確認門診流程架構適切性................................ 35
3.2 門診等候因素架構表.................................... 39
3.2.1彙整門診等候時間因素架構表............................ 39
3.2.2確認門診等候時間因素架構表............................ 47
.2.3審核門診等候時間因素架構表............................. 53
第四章 研究結果........................................ 59
4.1問卷設計.............................................. 59
4.2問卷調查..............................................64
4.2.1專家的選擇與基本資料...................................64
4.2.2問卷發放與回收........................................65
4.3資料分析...............................................66
4.3.1第二層之層級分析－構面權重..............................66
4.3.2第三層之層級分析－類別權重..............................67
4.3.3第四層之層級分析－因素權重..............................69
4.3.4門診等候時間因素整體權重值..............................74
4.4資料意函................................................80
4.5門診等候時間與服務品質相關性之調查........................ 81
4.5.1門診等候時間影響服務品質之調查與取樣......................82
4.5.2研究對象..............................................82
4.5.3問卷設計與實施........................................82
4.5.4問卷結果..............................................83
第五章 結論..............................................85
5.1 研究成果..............................................85
5.2管理意涵..............................................86
參考文獻.................................................88
附錄一 第一次KJ法成果....................................94
附錄二 第一次焦點訪談會議記錄..............................96
附錄三 第二次KJ法成果....................................97
附錄四 第二次焦點訪談會議記錄..............................99
附錄五 第一次德爾菲法問卷................................ 101
附錄六 第二次德爾菲法問卷.................................104
附錄七 第三次德爾菲法問卷.................................107
附錄八 層級分析法問卷.....................................110
附錄九 改善門診等候時間服務品質之研究問卷....................134
表2.1 T醫院門診表..........................................7
表2.2AHP運作上的原則.......................................26
表2.3AHP成對比較，評估尺度意義及說明..........................27
表3.1門診流程..............................................31
表3.2門診流程..............................................32
表3.3完成歸類門診流程架構....................................34
表3.4本研究之訪談大綱.......................................37
表3.5門診流程架構表.........................................38
表3.6門診等候時間因素.......................................40
表3.7門診等候時間因素.......................................41
表3.8門診等候時間因素之架構表................................43
表3.9門診等候時間因素之架構說明表.............................45
表3.10本研究之訪談大綱......................................48
表3.11門診等候時間關鍵因素架構表..............................50
表3.12德爾菲法問卷結果表.....................................54
表3.13德爾菲法問卷結果表.....................................57
表4.1 層級分析法評比尺度意義及說明............................60
表4.2 問題二之填寫範例......................................61
表4.3 問卷專家基本資料......................................64
表4.4 問卷作答行程表........................................65
表4.5 門診等候時間因素整體權重排序表..........................74
表4.6 門診等候時間架構權重量表...............................78
表4.7改善門診等候時間服務品質之研究問卷成果(醫療工作人員)........83
表4.8改善門診等候時間服務品質之研究問卷成果(病人)............. 84

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