以平衡計分卡建構公立醫院經營績效評估指標

Applying the Balanced Scorecard to Establish the Performance Indicators for Public Hospitals

長久以來，公立醫院經營績效欠佳的問題一直備受詬病，在高度競爭之 醫療市場，欲提升公立醫院經營績效，必須先建立績效評估拈標志統來衡量 監督績效，以作為績效改善之方向，然而公立醫院因兼負多重責任，除了滿 足病患的需求外，也要配合政府推動各項衛生政策，所以在建立公立醫院績 效評估系統時必須考量公立醫院使命及其營運上特殊性要求。 本研究以平衡計分卡（顧客面、財務面、醫院內部流程面、學習與成長 面）為主要無構，另新增加「社會責任與機構使命構面」，共五構面來建構績 效衡量在統。在研究方法方面，乃透過文獻探討、多次專家座談會與對公立 醫院問卷調查等方式，訂定各構面的績效拈標，之後，請相關專家學者針對 各項拈標以及五大績效構面進行重要性之比對，並利用分析層級程序法（Analytic Hierarchy Process） 分析每項構面與拈標之相對權重，以建立各構面綜 合績效拈標以及整體性綜合績效拈標。本研究結果最後將公立醫院分為「區 域級（含）以上醫院」與「區域級以下醫院」兩個類別，分別提出適合該類 別的績效評估拈標與權重，其中「區域級以上醫院（含區域醫院）」共53 項拈 標，「區域級以下醫院」共46 項拈標。 依本研究結果對衛生主管機關提出下列建議：實施績效拈標評比並定期 修正績效拈標、考量其他非營運因素對公立醫院績效的影響、參考非量化經 營績效的表現、維持公立醫院社會責任與機構使命的功能。對公立醫院的建 議為：參考本研究之績效拈標進行經營績效自我評估與監控、強化社會責任與機構使命的績效表現、因應外部環境與經營目標調整績效拈標。

The public hospitals operation performance has been criticized for a long time. It is imperative to improve public hospitals operation performance when the health care market is becoming highly competitive. Thus, in order to assess the public hospitals performance, at first, we need to establish the indicators of performance for the public hospitals. Public hospitals have the responsibility to provide the health care services meeting the patients needs, but they also need to assume government s special missions and responsibilities for the society, which should be taken into account for the indicators of operation performance. This study applied the balanced scorecard theory to create the performance indicators, which consists of financial, customer, internal business processes, and learning & growth aspects. In order to reflect the public-ownership characteristics, we added social responsibilities and organization s missions to be the fifth aspect in the performance indicators. By literature reviews, expert panel meetings, and mail surveys, we construct performance indicators for the public hospitals. Finally, we held the expert panel meeting to assess the weight of importance for the indicators. Then, we used analytic hierarchy process (AHP) method to analyze the relative weight of importance for the indicators. This study separated the public hospitals into two groups for the performance indicators. One group is the upperregion- level hospitals, and another group is the lower-region-level hospitals. For the upper-region-level hospitals, totally there are 53 performance indicators. For the lower-region-level hospitals, there are 46 performance indicators. Based on the study results, we propose the following recommendations: first, for the health policy decision makers: implement this performance indicators system and periodically adjust the performance indicators; take into account the impact of non-operation factors on hospital s operation performance; simultaneously consider the non-quantification indicators; and continuously maintain the function of public hospitals for the society. For the public hospitals: improve the operation performance according to the indicators of this study; and enhance operation performance in the aspects of hospitals social responsibilities and organization s missions; adjust the indicators according to the changes of external environment and operation goals.