醫院建立內控機制之探討

A Study on the Establishment of Internal Control Mechanism in Hospitals

內部控制是整合醫院內部各種管控及評核措施的管理過程，包括控制環境、風險評估、控制作業、資訊與溝通及監督作業等五項互有關聯的要素組成。由醫院監督與治理團隊核准，管理團隊設計並由機構全體人員共同執行，藉以合理促使醫院提高醫療品質、維護病人安全、提升營運效能、保障設施及設備安全、提供可靠資訊及遵循法令規定等目標的達成。衛生福利部為保障病人安全及提升醫療品質，定期辦理醫院評鑑，是以醫院共通的規範來評核醫院各項營運管理效能與醫療品質的程度。而醫院能通過外部審查的機制，達到價值提升及永續生存的目標，係仰賴以營運活動為主體所設計、執行與監督的內部控制制度的持續運作。本文將在醫院通過醫院評鑑審查的基礎上，提出以營運活動為架構的內部控制制度並使之完善的作法，及從稽核的角度看醫院財務內控機制的範圍及運作。

Internal control is a managerial process by which various control and assessment measures are integrated. It comprises of five major inter-relevant elements: environmental control, risk assessment, control activities, information/communication and monitoring system. The internal control system should be approved by the supervising and governing team a designed by the administrative team and carried out by all staff members of a hospital. By doing so, the following objectives could be achieved: reasonably enhancing the quality of medical care, ensuring patient safety, upgrading operational efficiency, ensuring facility and equipment safety, providing reliable information and complying with codes and regulations as required by the authority. In order to ensure patient safety and improve the quality of medical care, the Ministry of Health and Welfare has implemented a system of periodic hospital accreditation, by which hospitals are reviewed through a set of universal standards and requirements for assessments of their performance in management efficiency and care quality. A hospital could rely on the continuous operation of a system of internal control designed, executed and supervised basing on its operational activities to pass such an external review in achieving the goal of added value and sustainability. A system of internal control mechanism based on the operational activities of hospitals meeting the requirements of hospital accreditation (TJCHA) would be proposed. Methods for refinement of the system and the scope and operation of internal control on financial systems of hospitals from the audit point of view would also be mentioned.