運用平衡計分卡提升急診績效之探討

1. 運用平衡計分卡提升急診績效之探討 • 在面對競爭日益激烈的醫療環境中，醫療機構尤其是急診如何取得競爭優勢，一套完整績效評估制度是必要的。平衡計分卡即是一種有效的績效衡量制度，它可協助醫療機構將經營的策略轉化為實際的行動方案，目的在使策略易於付諸執行，並有效促進策略的達成及願景的實現。本研究的目的在建構一完整之平衡計分卡於急診及比較急診運用平衡計分卡實施前及實施後績效之差異性。本研究設計為描述比較性研究，採立意取樣，取自雲嘉地區某一區域教學醫院之急診的所有工作人員及病患。研究工具採結構式問卷調查，收案時間為91年2月10日起至91年5月15日，病患問卷共發出250份，回收有效問卷為204份，回收率為81.6%；急診工作人員問卷共發出87份，回收有效問卷為80份，回收率92%。本研究於91年2月15日起針對急診實施平衡計分卡，在人員學習與成長方面 : 實施急診員工服務應對禮儀教育訓練、急診服務關鍵時刻標準應對用語、電話服務禮儀標準應對用語、設計急診績效獎金作業辦法；在內部流程方面 : 制定檢體送出標準作業流程、設立單一窗口傳送急診檢體；在財務方面 : 規劃成本概念教育訓練、修定急診衛材計價單、建立正確計價作業流程及實施約雇制度；在顧客方面 : 建立顧客抱怨處理基本模式、設置申訴專線以探討抱怨事件發生原因及改善。資料以描述性統計分析員工及病患性別、年齡、婚姻狀況、教育程度、職業、員工職稱、薪資、急診服務年資及總年資、檢體退件率、30分鐘內未完成之檢驗率、收入成長率、在職教育時數及病患抱怨率。以配對t檢定員工滿意度及獨立t檢定病患滿意度。研究結果顯示如下 : 一、在員工學習與成長構面: (一)工作滿意度實施前70.8%，實施三個月後為82.3%，員工滿意度提升11.5%。(二)在職教育時數每人每月平均接受4.3小時教育訓練增加至9.7小時。二、在內部流程面 :(一)30分鐘內未完成之檢驗率，在生化檢驗項目由 12.8% (487/3795件數)降為8.3% (330/3992件數)；血液項目由4.7% (215/4552件數)降為1.6% (73/4572件數)；尿液項目由5.6% (82/1464件數)降為1.7% (27/1627件數)。(二)檢體退件率由3.5% (289/8347件數)降為2.1% (177/8584件數)。三、在財務面: (一)收入成長率實施前為1.44%，實施後為3.27%，其收入成長率增加1.83%。四、在顧客面: (一)病患滿意度實施前76.3%，實施三個月後病患滿意度為86.8%，滿意度提升10.5%。(二)病患抱怨率實施前0.28% (38/13803人)，實施後為0.1% (15/14364人)，減少0.18%。由本研究結果可以了解，平衡計分卡之介入後其各項績效指標明顯的提升，期望這個研究結果可以提供給未來醫院管理者、各區域醫療院所做為提升急診績效之參考，甚至推廣到急症以外的其他單位。關鍵詞 : 平衡計分卡、急診

2. Using Balanced Scorecard to Improve the Performance at an Emergency Department • Facing the increasing in competition in health care, it is needed for hospitals, especially for an emergency department to have a comprehensive performance evaluation tool to obtain competition advantages. A Balanced Scorecard (BSC) is one of the effective performance evaluation tools for hospitals to transform business strategies into concrete actions. The aims of the BSC are to put strategies into effects, to reach goals, and to achieve hospital visions.The purposes of this study were to build the BSC at an emergency department and to compare the differences before and after the BSC was implemented. The research design was descriptive and comparative. A purposive sampling was used to collect data from an emergency department at a district hospital in Chi-I. A structured questionnaire was used to collect data from all the staff and visited patients at this emergency department. Data were collected from February 10, 2002 through May 15, 2002. 250 questionnaires were sent out for patients who visited emergency department at study period and resulted 204 valid questionnaires. 87 questionnaires were sent out for all staff and resulted 80 valid questionnaires.The BSC was implemented on February 15, 2002 and included four domains: 1) learning and growth: including practicing standard courtesy training, communication and telephone skills training, and designing cash award scheme for job performance, 2) internal business process: including making the standard process for laboratory tests, and one-way delivery service; 3) financial: including planning cost concept training, revising material cost sheets, practicing standard counting process, and enacting appointing system; and 4) customers: including setting special telephone line for complains and find ways for improvements.Gender, age, marriage status, education level, occupation, income level, past and total experience at an emergency department, laboratory return rate, incomplete test within 30 minutes, number of services, and financial growth rate, continuing education hours, and complain rates were analyzed using descriptive analyses. The job satisfaction by all staff was analyzed with paired-t test. An independent-t was used for patient satisfaction.The results showed that job satisfaction was increased from 70.8% to 82.3% during 3-month study period. Continuing education hours were increased from 4.3 hours to 9.7 hours per person every month in learning and growth domain. In internal business process domain, the rate of incomplete biochemical test within 30 minutes was decreased from 12.8% to 8.3%, blood test decreased from 4.7% to 1.6%, urine test decreased from5.6% to 1.7%, and culture return rate decreased from 3.5% to 2.1%. In financial domain, revenue of emergency unit was increased from 1.44% to 3.27%. In customer domain, patient satisfaction was increased from 76.3% to 86.8%, and the rates of patient complain decreased from 0.28 to 0.1%.The result indicated that all performance indicators were improved obviously after the BSC was implemented. Hopefully, the results can be as a reference for hospital administrators, district hospitals to improve performance at emergency departments and even be used in other departments.Key words : Balanced Scorecard (BSC), Emergency department