某醫學中心手術團隊生產效率之評估

A comparison of production efficiency across surgeon teams in one of medical center

本文利用資料包絡分析（Data Envelopment Analysis, DEA）檢視台灣某醫學中心十五個手術團隊生產效率，採用開刀日手術房間數、主治醫師人力和護理人工時為三個投入變項，三個產出變項為手術例數、手術時間和手術金額，以CCR模式、BBC模式衡量2003~2005年各團隊之整體效率、技術效率和規模效率。三年度整體效率為0.7031、0.7147、0.6607，技術效率為0.8459、0.8264、0.7735，規模效率為0.8485、0.8817、0.8757。依效率值大小排名顯示，整形、胸腔科團隊在整體效率與規模效率分列第一、第二，而腫瘤團隊在整體與技術效率皆屬第三名，皮膚科出現二次第十五名。經事後檢定發現，整體效率以整形、胸腔、腫瘤、胃腸四個團隊顯著高於皮膚、泌尿、婦產、耳鼻喉、眼科團隊；技術效率以皮膚、骨、腫瘤、整形團隊顯著高於婦產、耳鼻喉、眼、泌尿團隊；規模效率以整形、胸腔、眼、婦產、心臟團隊顯著高於皮膚科、骨科。手術團隊於三年度生產效率之上升或下降趨勢，未達統計上顯著水準。將整體效率區分為低與高兩組，相對效率低者其醫師人力為7人、相對效率高者為4.2人，兩組的醫師人力具顯著差異，而護理人工時、開刀日手術房間數之投入，在高低兩組並無顯著差異；產出變項中，總手術例數、時間與金額在高與低兩組之差異未達顯著。進一步藉由差額變數分析，調整各專科於手術室之投入與產出，以達改善目標。

We measure the production efficiency cross fifteen surgeon teams of Kaohsiung Medical University Hospital (KMUH) in Taiwan by using the CCR and BCC model in data envelopment analysis (DEA). We adopted three inputs including the number of operation room used for elective surgery, the manpower of physician and nurse; and three outputs including the total number, total time, and total payment of surgeon case. Our results showed the aggregate effiency was 0.7031, 0.7147, 0.6607, technical effiency 0.8459, 0.8264, 0.7735, as well as scale effiency 0.8485, 0.8817, 0.8757 during 2003-2005, respectively. Further, it also indicates that the efficience of surgeon team by plastits, oncology, gastroenterology better than that of dermatolohy, urology, ophthalmology. However, the dermatolohy and orthopaedics teams appeared over-sized and inefficiencies of scales even if their technical efficiency better than that of team for plastits, oncology, obstetrics, and ophthalmology. We also use slack variable analysis (SVA) to access the degree of improvement in production ratio of inputs and outputs.