醫學中心營養室作業流程分析與再造之研究

Analysis and Re-engineering of the Operation Processes in the Nutrition Department of a Medical Center

本研究乃針對中部某醫學中作業流程進行流程改造，該院每年多達約541,000人次以上使用管灌飲食及餐盤飲食，如此頻繁且密集的作業需求造成管理上的困難透過流程分析發現管灌飲食六項問題點（1）因表單不適用於現行流程，造成作業效率不彰；（2）因作業方式不當易產生錯誤；（3）因缺少報廢流程造成管理者無法掌握報廢成本與原因；（4）因流程缺乏資訊化造成人工作業成本增加及錯誤率較高；（5）因物料流與資訊流脫節造成無法掌握物品實際耗用量；（6）因統計表單設計不當，無法提供管理者所需資訊。另外在餐盤飲食作業有四項問題點：（1）因餐條系統設計不良造成作業不便及修改次數過多；（2）在第二醫療大樓午餐盤參與權辦留供餐作業中，配膳人員工作分配不均，造成作業效率不彰；（3）因缺少促銷及客群定位，導致訂餐率太低；（4）自費餐飲收入因受限現行訂購機制造成該收入無法提升。為解決上述管灌飲食作業之問題，本研究提出八個步驟所構成的改善方案：（1）建立罐時間人員作業表單取代個別製作單；（2）重新設計飲食變更通知單與作業方式；（3）將標籤導入現有作業取代餐條黏貼；（4）建立送餐表餐取代餐條送餐；（5）增加管灌飲食報廢申請流程；（6）重新設計第二醫療大樓罐裝灌食領貨流程；（7）增加灌食間及第二醫療大樓小庫房的盤點流程；（8）建立營養室資訊系統。另外，為解決盤餐飲食作業之問題，提出下列五個改善的方向：（1）建立新餐條系統；（2）利用裝配線平衡之手法，重新分配第二醫療大樓午餐盤餐與全半流供餐配膳人員之工作內容；（3）增加促銷管道並以顧客面為出發點進行促銷，以提高訂餐率；（4）更改現行訂購機制，開拓新客源，提升獲利；（5）建立營養是盤餐訂餐資訊系統。經謹慎之評估，本研究預計改善管灌飲食之八步驟，及五個改善盤餐飲食之方案，不僅可以有效解決營養室作業的各項問題，且可協助個案營養是每月節省約$22萬1千元。

This study focus on the re-engineering of Tube-Feeding-Diet (TFD) and Tray Meal Diet (TMD) operation processes in the Nutrition Department of a Medical Center. In the concerned case, the Nutrition Department has to serve 541,000 person-times TFD and/or TMD per year. Such intensive requirement jeopardizes the quality of the operation processes in the Nutrition Department. After conducting business process analysis and re-engineering, there are six major problems in TFD service process: (1) The inappropriate design of the existing tables and sheets leads to inefficiency in the operation processes. (2) Frequent mistakes occur because of the improper operations in the processes. (3) The manager is not able to obtain a precise measure of the discarding cost. (4) Without the assistance of an effective information system, it results in both increasing cost from intensive manual operations and good possibility of making mistakes. (5) The manager suffers from the problem of no complete and accurate information of the amount consumed. (6) The manager is not able to fetch necessary managerial information from the statistical sheets. On the other hand, there are four major problems in TMD service process: (1) Inappropriate design of the existing catering card operating system leads to inconvenience in the operation processes. (2) Inefficiency in the operations occurs because of the unequally working loading assigned to the staffs in food service. (3) Low subscribing rate of Tray Meal and Liquid Diet results from lacking of promotion and market segmentation. (4) It is difficult to increase the revenue of partial catering because of the restriction of existing subscribing system. In order to solve the problems in TFD service process, we propose a eight-step procedure as follows. (1) Design new tables and sheets to replace the inappropriate ones in the TFD service operation processes. (2) Modify the design of the diet-change order sheet and change the operation processes. (3) Replace the existing diet-sheet with a new self-sticking label accompanying with a new design that shows clear and necessary information. (4) Introduce new catering tables and sheets to replace the existing ones. (5) A discarding procedure is proposed for the TFD service operation processes. (6) Modify the receiving process of commercial packaged TFD in the second medical service building. (7) Propose an inventory checking mechanism for the two secondary storage units in the TFD kitchen and the Second Medical Service Building. (8) Establish a new web-based information system to assist the Nutrition Department in the TFD service operation processes. On the other hand, we propose five action items to solve the problems in the TMD service processes: (1) Design a new catering card operating system. (2) Modify working loading assignment to the staffs in food service equally by using the assembly line balancing method. (3) Initiate perspective promotions to increase the meal-subscribing rate. (4) Modify the existing subscribing system to explore new sources of clients so as to increase the total revenue. (5) Establish a new web-based information system for the subscription of TMD in the Nutrition Department. Following cautious assessment, the Nutrition Department not only is able to effectively solve the problems using the eight action items in the TFD service process and five action items in the TMD service process, but also would secure a cost-saving of $NTD 221,000 each month for the case hospital.