公立醫院垂直整併模式之成效－－以某署立區域級教學醫院為例

Analyzing Performance of Public Hospital Vertical Integration Model—An Example of a Department of Health owned Regional Teaching Hospital

本研究之目的在探討某署立區域級教學醫院與公立醫學中心組織垂直整併模式之成效。整併改制前三年先由該醫學中心以醫師支援方式進行醫療合作，改制後該區域醫院成為醫學中心之分院並致力於組織體質改造，並建構策略核心組織。本研究以情境診斷（SWOT）分析改制為醫學中心分院之優勢、劣勢、機會及威脅，並以平衡計分卡之學習與成長構面、內部流程構面、顧客構面及財務構面等探討改制後之成效。平衡計分卡12項策略性衡量指標經簡單線性迴歸分析結果顯示，共10項指標有顯著變化，其中9項指標有顯著改善，即專任主治醫師人數、論文及學術發表篇數、急診轉診回覆率、創新醫療服務項目數、每日急診人次、接受創新治療人次、急重症醫療收入、實質固定資產報酬率及實質賸餘率等；1項指標有負面影響，為內部流程構面之病人候藥時間。病人候藥時間雖由92年的7.3分鐘增至96年為12.2分鐘，達顯著意義，但仍少於同等級區域教學醫院平均候藥時間（15分鐘）。2項無顯著迴歸變化之指標為：員工滿意度與病患滿意度。整體而言，該院改制模式已可見具體成效，成功經驗可做為未來推動垂直整併機構之參考。

The purposes of this study were to evaluate the performance of the vertical integration model of a regional teaching hospital and a public medical center. Three years before the organization reform, the medical center proceeded a medical collaboration by arranging physicians to support medical services. After reform, the regional hospital became a branch hospital and devoted its energies to organization re-engineering and constructed a strategy-focused organization. This research used the framework of SWOT to analyze the strength, weakness, opportunity and threat of the reforming strategy. This research also implemented the learning and growth perspective, internal process perspective, customer perspective, and the financial perspective of Balanced Scorecard (BSC) to examine the performance after reforming. Results of simple linear regression of 12 strategic indicators of Balanced Scorecard (BSC) show that 10 indicators have significant differences and 9 indicators with significant improvements, including number of full-time attending physician, number of publications and research projects, response rate of emergency referral, number of innovative medical services, number of emergency visits in a day, number of patients with innovative therapy, revenue of critical care medicine, actual fixed assets return, and actual return. But there was an indicator, i.e. patient waiting time, showed negative impact. Although patient waiting time increased significantly from 7.3 minutes in 2003 to 12.2 minutes in 2007 it was still shorter than the average waiting time (15 minutes) for all of the regional teaching hospitals. Two indicators without significant difference were employee satisfaction and patient satisfaction. Above all, the hospital reform model showed positive results when analyzed with the BSC framework. The successful experiences could be a reference for institutions going to implement vertical integration in the future.