創新醫療服務之動態績效評估 - 以台大醫院病患自控式止痛服務為例
余峻瑜、郭瑞祥、蔣明晃、曹若琳
摘要
近年來，醫療產業之中的競爭局勢越來越白熱化，醫療機構為了爭取資源與病人，積極導入各種經營管理工具來推動服務創新。為了確保創新醫療服務的績效與品質能夠符合原訂的設計目標，必須規劃適當的績效指標來進行評估。平衡計分卡 (Balanced Scorecard, BSC) 即是其中一項被寄予厚望的思維與手法。不過由於醫療系統的高複雜度與高動態性，使得績效指標之間的因果關連性不易掌握，進而限制了平衡計分卡的推動效益。系統動態學 (System Dynamics, SD) 善於分析處理動態且複雜的因果環路與網絡，並能夠同時解決時間延遲的問題，因此本研究結合系統動態學的觀點來發展能夠評估創新醫療服務績效的平衡計分卡。本研究探討台大醫院麻醉部目前病患自控式止痛 (Patient Controlled Analgesia, PCA) 創新醫療服務，這是目前手術後止痛最有效也最被推薦的方法，不過這項創新服務在推廣過程中，營運績效與病人接受度方面仍有持續改善的空間。因此，本研究深入觀察並訪談台大醫院 PCA 小組，針對其創新服務系統建立平衡計分卡，進而運用系統動力學方法，釐清並描繪 PCA 績效指標之間的因果環路網絡，以 Vensim 模擬軟體進行模擬與測試，探究績效指標之動態變化。本研究亦針對模擬結果進行敏感度分析，探討其管理意涵與實務應用建議。
關鍵詞：平衡計分卡、系統動態學、醫療服務創新、動態績效評估
Dynamic Performance Evaluation for Innovative Healthcare Service – A Case Study for PCA Program at NTUH
Jiun-Yu Yu, Ruey-Shan Guo, Ming-Huang Chiang, Ro-Lin Tsao
Abstract
The aim of this paper is to develop an organizational performance evaluation framework that takes account of the dynamical system behaviors for innovative healthcare service. Interactions among key performance indicators and delay effects between causal relationships are explicitly modeled and integrated into the traditional Balanced Scorecard structure. The research method and model proposed in this paper have been applied to an innovative healthcare service developed and implemented in the Department of Anesthesia, National Taiwan University Hospital. In healthcare industry, Balanced Scorecard (BSC) is a very commonly applied tool for organizational performance evaluation. However, nowadays as healthcare system becomes more and more dynamic and complicated, BSC has limited ability to deal with dynamical complexities such as the interactions among key performance indicators and the effect of time lag. To investigate the impacts of these dynamical complexities on the organizational performance, the system dynamics approached is applied. Thus, a dynamic balanced scorecard is proposed by integrating BSC and system dynamics for managing the performance of innovative healthcare services. By a case study for National Taiwan University Hospital (NTUH) Patient Controlled Analgesia (PCA) program, a set of key performance indicators (KPIs) based on BSC framework and the current practice of the NTUH PCA team is developed. The interactions and causal dynamics between the KPIs are further investigated, and the dynamic balanced scorecard based on the system dynamics framework is proposed by conducting intensive interviews with the PCA team. Finally, a system dynamics simulation model is developed using software, Vensim, to study the effect of each driver that contributes to the better performance of the NTUH PCA team. A series of sensitivity analysis is implemented, and a number of policies for performance improvements are suggested for the NTUH PCA team. The results of this study suggest that the performance of the NTUH PCA team can be improved significantly via the four drivers discussed in the system dynamics simulation model and that a reallocation plan for the current resource may have positive contribution.
Keywords: New Product Introduction, System Dynamics, Project Management
Received: 2018-01-18
Accepted: 2018-02-14