現今，醫療業在總額給付環境，正面臨愈來愈難經營醫療環境，及病患導向需求環境，良好的醫療服務態度及組織的變革是必需的。 因此，許多醫療服務必需提供標準化與額外服務。本研究藉由參與式管理與工作豐富化等理念，改善提供超音波服務。由兩方向進行，首先建立婦產部超音波服務路徑包括建構婦產科超音波檢查流程圖、顧客接觸點、以及檢核表，完成婦產科超音波服務路徑。其次分析全面服務( Total service )的時間，包含婦科與產科之事前、實際、事後服務之時間測量，分析與確認所建構之服務路徑。

研究結果顯示超音波服務路徑實施後: (1)全面服務時間:婦科方面減少，產科方面增加。(2)婦科方面:事前與事後服務時間減少，在服務路徑實施前後有顯著性差異，經相關因子分析，在事前提供完整的衛教，不僅縮短準備的時間且在事後知道該如何，能有效減少事後服務的時間，實際服務從原先檢查期間無對談到加入示範性對話，反而增加了實際服務的時間 。(3) 產科方面:實際服務的時間反而縮短推測由於標準對話實施，產婦較無額外的問題。

藉由服務路徑的建構與實施學習，能提供婦產部病患高品質的超音波服務，醫療人員能夠積極與顧客互動及在工作人員不斷提昇與再教育下，讓患者感受到高品質的服務，並成為醫學中心中最有口碑的單位。本研究經驗應可推及其他單位以提供較佳醫療品質，更能將醫療標準化、無形中增加財務方面的營收、創造醫院的新形象更能達到永續經營目的。

關鍵字:服務路徑、全面服務、婦產科超音波檢查

Nowadays, the hospital managers are facing increasing financial difficulties, because of the global budget policy from the national health institute. Patient-oriented services, good manner of the care providers, and the rapid response of the hospital to the medical environment are among the important factors for hospital survival. Therefore, many medical care providers had designed the clinical pathway for standardized medical treatment to control the medical costs, but they also allowed some extra-services for attracting and recruiting more patients. In this study, by way of participating management and job enrichment, we try to improve the quality and the patient satisfaction of the pelvic sonography provided by Obs/Gyn department.

The study was proceeded in 2 ways. First, we designed a standardized obstetrical and gynecological sonography service pathway, which include a standard flow chart, customer encounter, and a checklist. Second, we measured the total service time duration, including those of pre-service consultation, actual sonography performing, and the post-service consultation. The measurements were performed before and after the application of the standardized sonography pathway. The measurement results were used to analyze and evaluate the validity and efficiency of the originally designed pathway.

The study results demonstrate that after application of the sonography pathway, the total service time duration is reduced in Gyn sonography, but increased in Obs sonography. For Gyn sonography, the duration of pre-service consultation and post-service consultation were significantly reduced after application of standardized pathway. Further analysis revealed that thorough pre-service consultation not only made our patients more comfortable, but also reduced the post-service consultation time. However, the actual sonography performing time was increased, because of the adding of the standardized conversation. For obstetrical sonography, the duration of the actual sonography performing time was decreased, possibly due to the adding of standardized conversation, which answered most of the questions that the pregnant patients want to know about.

In conclusion, by way of establishment and repeated reassessment/correction of the standardized sonography pathway, the quality of the sonography services can be greatly improved, and the patient’s satisfaction can be even greater. The same experience can be applied to other fields. The quality of medical care can be more stable by the application of standardized clinical pathway. Besides, through the efforts of quality control, the medical cost can be limited, and the financial burden of the hospital and medical care providers can be reduced, making a double-win medical environment.





Key Word: service pathways,total service, Obs/Gyn sonography

表目錄 III
圖目錄 V
誌謝 VI
摘要 VII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 4
第二章 文獻探討 5
第一節 婦產部超音波 5
第二節 服務路徑 10
第三章 研究方法 16
第一節 研究架構 16
第二節 研究個案介紹 19
第三節 研究限制 23
第四章 研究結果與討論 24
第一節 超音波服務之描述性統計 24
第二節 各婦產部疾病之描述性分析 47
第三節 服務路徑之建構 50
第四節 全面服務時間之分析 53
第五章 結論與建議 59
第一節 結論 59
第二節 建議 62
參考文獻 65
附錄 73

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