品管圈活動運用於解決醫院單位成本問題之實務：以某復健中心為例

Using Quality Control Circle to Dispose of the Cost Problems in a Medical Unit: An Experience of Rehabilitation Center

成本控制在企業經營中具有重要的地位，醫療單位的成本分析及問題解決，能有助於醫院整體的開源節流的永續發展，本研究的目的將運用品管圈活動分析並解決單位的成本問題。在某地區教學醫院兒童發展復健中心，由六位中心的治療師組成追蹤圈，會議討論改善單位成本的問題，採用專業評估舉證討論，選出遺漏健保申報情況為主要問題進行解決。由於治療與掛號業務並行，無登錄健保卡產生遺漏健保申報，是單位常見的問題。由品管歷史架構採問題解決型步驟，收集前三個月的遺漏申報查檢表，依80/20理論來挑選要改善的主要原因，發現（第一項）家長報到流程不熟（45%）及（第二項）治療師未確實執行先報到再治療（35%）為真因，並擬定改善對策。根據遺漏申報查檢表，改善前三月平均漏帳件數為20.3件，進行一個月的對策實施，計算改善後的降幅值。改善後當月總遺漏件數為9件，降幅值為55.67%。進一步分析各項對策結果，在第一項對策的降幅值達60%，在第二項對策的降幅值達63.99%。因改善情況良好，也書面化標準作業流程，持續執行進行改善。

Cost control is critical to the management of enterprise. The costs analyze and problem solving of a medical unit can help a hospital to cost down and good for long term development. The purpose of this research is to analyze and solve the cost problem of a medical unit by using quality control circle activity. Six therapists in a rehabilitation center of a teaching hospital form a trace circle and try to improve the cost problem of the unit. We use professional evaluation to give proof for discussion and choose health insurance registration omission as our topic to handle. As health insurance registration and rehabilitation program were execute at the same time, so the omission of health insurance registration was a common problem of the medical unit. We used Quality Control story to take steps for problem solving, collected checklist recorded the registration omissions of the last three months and used 80/20 theory to choose the main factors to improve. We found that (1st item) patients’ families did not understand the registration process (45%) and (2nd item) the therapists did not confirm the registration before therapies (35%) were the real reasons, and we planned the strategy to handle it. According to the record of registration omission checklists, the amount of registration omission was 20.3, after one month’s strategy execution we calculated the improvement range. We found that after the improvement the amount of omission was 9, decreasing rate is 55.67 %. The decreasing rates of registration omission caused by 1st and 2nd item were 60 % and 63.99 %. As the improvement is good, we compose it to a standard of process and keep executing it.