應用HQKMS-DMAIC方法論建立醫療品質指標管理機制

Application of HQKMS-DMAIC Methodology for Establishing a Mechanism of Medical Quality Management

醫療品質指標是評值與衡量醫療品質的重要工具，近年來為提升台灣醫療品質，屬台灣的醫療品質指標系統正如火如荼發展中。本文以HQKMS-DMAIC方法論建立醫療品質指標管理機制：「定義」以TCPI要素為基準，整合TCPI、QIP與P4P系統之資料要素；「衡量」以管制圖與同儕資料作為衡量工具；「分析」以落於管制圖＋2SD或＋3SD之外為判讀規則之標準；「改善」依管制圖判讀規則之標準、指標監測議題之重要性與急迫性決定；「控制」為持續監測、追蹤品質之穩定性。應用HQKMS-DMAIC方法論建立之管理機制，有助落實醫療品質指標監測日常化，不但有助病人安全的保障，改善醫病關係，更可促進醫療品質不斷提升與精進。

Medical quality indicators are keys to evaluate the performance of medical quality. We proposed a “hospital quality knowledge management system” (HQKMS), where the DMAIC methodology was implemented for medical quality management. In the HQKMS- DMAIC process, first in the “Define” phase, all medical quality indicators such as TCPI, QIP and P4P are defined to be the core data sets for quality performance measures. Secondly, in the “Measure” phase, control charts and the measurement unit for benchmark are determined as knowledge sets by professional users. In the “Analyze” phase, the system shows signals where there seems to have significant changes in one of the major indicators, or to have urgent attention or actions taken. Relevant solutions and decisions follow immediately in the “Improve” stage, to help the hospital quality management team achieve the desired objectives. Finally, in the “Control” phase, continuous monitoring and tracking the performance indicators by the HQKMS ensure the service quality and stability.