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系統識別號 U0026-2206201117535200
論文名稱(中文) 應用緩衝管理於健康檢查作業排程之研究
論文名稱(英文) Using buffer management in health examination scheduling
校院名稱 成功大學
系所名稱(中) 工業與資訊管理學系碩博士班
系所名稱(英) Department of Industrial and Information Management
學年度 99
學期 2
出版年 100
研究生(中文) 廖雅玫
研究生(英文) Ya-Mei Liao
學號 R36994088
學位類別 碩士
語文別 中文
論文頁數 78頁
口試委員 口試委員-宮大川
口試委員-謝昆霖
口試委員-彭泉
指導教授-呂執中
中文關鍵字 健康檢查  多專案管理  緩衝管理  限制驅導式排程  專案排程 
英文關鍵字 medical examination  multi-project management  buffer management  Drum-Buffer-Rope scheduling (DBR scheduling)  project scheduling 
學科別分類
中文摘要 近來隨著「預防勝於治療」的觀念普及,我國民眾對定期健康檢查的接受度亦逐年提高。在此潮流下,政府於民國八十四年推行全民健康保險,亦推行許多成人預防保健項目。然而,其補助對象僅限制於四十歲以上,且實施項目有限,無法滿足多數民眾需求,間接導致自費健檢市場因而逐漸擴大;由於,自費健檢市場利潤相對豐厚,吸引民間乃至公立醫院亦積極投入此一大餅。就健檢活動而言,安排受檢者接受各式檢查項目是健檢作業中的一大重點;但由於多數健檢中心的資源配置有限(如設備、場地等),且受檢者於檢查流程進行時,易遭受到諸多限制與突發狀況等影響,進而導致延誤健檢時間或無法如期完成的現象發生。因此,如何提高資源使用效率並提供完善的排程系統,已是健檢中心當前面臨之難題。
儘管大部分健檢議題屬於醫療領域,但其流程化及有限資源配置的特性與專案管理相符;故本研究將專案管理概念應用於健康檢查流程中,視其為一個多專案環境。此外,在專案環境中,認為唯有如期達交才能使企業產出達到良好績效,而影響專案績效不良因素即為瓶頸。而限制驅導式(Drum-Buffer-Rope)排程理論在面臨資源有限時能提升流程掌控效率,因此論文中將利用緩衝管理(Buffer management)以及限制驅導式建構一個排程模式,協助健康檢查中心能在不改變現有資源與作業模式情況下,提高流程控制效率。
本研究為驗證模式的可行性,以一個健檢中心為個案案例,透過模擬模式進行導入前後的效益驗證。比較結果發現,在如期完成比例方面導入排程模式後提升13%,且資源使用率也提升約20%,表示緩衝管理與限制驅導式在安排健檢流程上能有明顯的排程績效。其中,緩衝管理在監控健檢流程中,能大幅縮短受檢者等待時間,且面臨變動的環境時亦能有彈性的應付空間,使受檢者較能如期完成健檢程序,同時也提高健檢中心的產出績效。
英文摘要 There is a higher acceptance of periodic medical examination for people in Taiwan recently with the growing popularity of the concept which states “Prevention is better than cure.” In retrospect of when the program of National Health Insurance or the NHI was initiated in 1995, the government also promoted the Adult Preventive Health Care or the APHC. Nevertheless, the APHC are only subsidized for people over 40 years old and it covers only a few items, which do not come up with most people’s expectations and thus leads to a growing market indirectly where people are taking medical examinations at their own expense. This rather profitable market hereinbefore had appealed both private and public hospitals to sharing the “pie.” As a matter of fact, the arrangement for one person taking various medical examinations is one for emphasis in the whole operations; however, limitations such as resource allocation, equipment, space, and other contingencies might delay or impede the process. Therefore, it has been the baffling question as how to promote resource utilization efficiency and to provide a well-defined scheduling system.
Despite the fact that most health examination issues pertain to medical science, their attributes such as operations streamlining and limited resources allocation are consistent with the subjects in project management. So in this study, we try to apply these concepts derived from project management to the medical examination processes and consider as if they were in a multi-project environment. In addition, mal-performance is deemed a “bottleneck” in project management while we believe that punctuality can bring higher performance to the institutions, and we also find that the Drum-Buffer-Rope scheduling could promote and control efficiency of operations in the face of limited resources. So, we will introduce the Buffer Management and the Drum-Buffer-Rope concepts to construct a new scheduling model, which will in turn assist the physical examination center to improve and control efficiency without changing its current operating model.
Finally, in order to validate the feasibility of the newly-built model, we take the case of a physical examination center, in which the validation was carried out through comparing the data before and after the simulated model was introduced. The proportion of completing medical examinations in time has improved by 13%, and the resource utilization rate has also improved by 20%, which means that there is a significantly better performance of scheduling after introducing the buffer management and the Drum-Buffer-Rope scheduling. Especially, the buffer management could greatly reduce delay, and it has more flexibility in the face of the ever-changing environment; which the buffer management not only provides a more punctual examining procedure but also promotes higher performance.
論文目次 摘 要 I
Abstract II
誌 謝 IV
目 錄 V
圖 目 錄 VII
表 目 錄 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究範圍 3
第四節 研究架構與流程 4
第二章 文獻探討 6
第一節 健康檢查 6
2.1.1 健康檢查定義 6
2.1.2 台灣健檢現況 7
第二節 健康檢查排程 9
2.2.1健康檢查排程定義 9
2.2.2排程評估之績效指標 11
第三節 限制理論應用 13
2.3.1限制理論之定義 13
2.3.2限制驅導式 14
2.3.2.1限制驅導式定義 14
2.3.2.2限制驅導式排程步驟 16
第四節 限制理論專案管理 17
第五節 緩衝管理 22
第三章 問題描述與模式建構 26
第一節 問題描述 26
第二節 假設條件 30
第三節 模式說明 32
3.3.1整體研究架構 32
3.3.2模式建構 33
3.3.2.1模式定義 33
3.3.2.2模式結構 34
3.3.2.3小結 42
第四章 個案研究與模擬系統分析 43
第一節 個案描述 43
第二節 模擬系統說明 47
4.2.1系統參數設定 47
4.2.2現況模擬模式建構 49
4.2.3改善模擬模式建構 54
第三節 應用分析 59
4.3.1情境一:不同健檢套裝分配比例 59
4.3.2情境二:不同受檢者人數 62
4.3.3情境三:不同產能緩衝大小設置 64
4.3.4小結 66
第四節 討論 66
第五章 結論與未來研究 70
第一節 結論 70
第二節 未來研究 72
參考文獻 73
附錄(一):現況模擬模式之驗證與確認
參考文獻 中文部分
李榮貴,張盛鴻,(2005),「TOC限制理論。」,台北:中國生產力中心。
呂俞鋒,(2009),「多專案關鍵產能緩衝配置方法與緩衝大小之設定。」,明新科技大學工程管理研究所碩士論文。
吳鴻輝,李榮貴,(2007),「限制驅導式現場排程與管理技術(修訂二版)。」,台北:全華科技圖書股份有限公司。
張玉旻,(2007),「關鍵鏈專案管理執行計畫之研究。」,國立交通大學工業工程與管理學程碩士論文。
陳明豐,(2005),「健康檢查與健康管理。」,健康世界第229期,82-86頁。
陳皇光,(2010),「善用健康檢查─疾病預防的利器。」,醫療品質雜誌,第4卷
第2期,20-23頁。
陳俊吉,(2008),「以啟發式方法解決具迴流性質之彈性流程式排程問題。」,國立政治大學資訊管理研究所碩士論文。
簡佩思,(2004),「健康檢查作業排程模式之研究。」,國立台灣大學資訊管理研究所碩士論文。
英文部分
Atwater, J. B., & Chakravorty, S. S., (2002), "A study of the utilization of capacity constrained resources in drum-buffer-rope systems," Production and Operations Management, Vol. 11, 2, pp. 259-273.
Anupindi, Chopra, Deshmukh, Mieghem, & Zemel, (2006), Managing business process flows (2nd ed.), New Jersey: Prentice Hall.
Beliën, J., Demeulemeester, E., & Cardoen, B., (2008), "A decision support system for cyclic master surgery scheduling with multiple objectives," Journal of Scheduling Vol. 12, 2, pp. 147-161.
Betterton, C. E., & Cox, J. F., (2009), "Espoused drum-buffer-rope flow control in serial lines: A comparative study of simulation models," International Journal of Production Economics, Vol. 117, 1, pp. 66-79.
Blackstone, J. H., Cox, J. F., & Schleier, J. G., (2009), "A tutorial on project management from a theory of constraints perspective," International Journal of Production Research, Vol. 47, 24, pp. 7029-7046.
Chacko, K. M., & Anderson, R. J., (2007), "The annual physical examination: Important or time to abandon?," American Journal of Medicine, Vol. 120, 7, pp. 581-583.
Chern, C. C., Chien, P. S., & Chen, S. Y., (2008), "A heuristic algorithm for the hospital health examination scheduling problem," European Journal of Operational Research, Vol. 186, 3, pp. 1137-1157.
Chien, C. F., Tseng, F. P., & Chen, C. H., (2008), "An evolutionary approach to rehabilitation patient scheduling: A case study," European Journal of Operational Research, Vol. 189, 3, pp. 1234-1253.
Chiou, C. J., & Chang, H. Y., (2002), "Do the elderly benefit from annual physical examination? an example from Kaohsiung city, Taiwan," Preventive Medicine, Vol. 35, pp. 264-270.
Cohen, I., Mandelbaum, A., & Shtub, A., (2004), "Multi-project scheduling and control: a process-based comparative study of the critical chain methodology and some alternatives," Project Management Journal, Vol. 35, 2, pp. 39-49.
Finkelstein, M. M., (2002), "Preventive screening - what factors influence testing?," Canadian Family Physician, Vol. 48, pp. 1494-1501.
Geekie, A., & Steyn, H., (2008), "Buffer sizing for the critical chain project management method," South African Journal of Industrial Engineering, Vol. 19, 1, pp. 73-88.
Goldratt, E. M., & Cox, J. F., (1984), The goal, Croton-on-Hudson, NY: North River Press.
Goldratt, E.M.,(1997), Critical chain, Great Barrington, MA: North River Press.
Gupta, M. C., & Boyd, L. H., (2008), "Theory of constraints: a theory for operations management," International Journal of Operations & Production Management, Vol. 28, 9-10, pp. 991-1012.
Hasgul, S., & Kartal, Z., (2007), "Analyzing a drum-buffer-rope scheduling system executability Through Simulation," Paper presented at the Summer Computer Simulation Conference, San Diego.
Hastings, N.A.J., Marshall, P.H., and Willis, R.J., (1982), "Scheduling based MRP: An integrated approach to production scheduling and material requirements planning," Journal of Operational Research Society, vol. 33, pp. 1021-1029.
Herroelen, W., & Leus, R., (2001) "On the merits and pitfalls of critical chain scheduling," Journal of Operations Management, Vol. 19, 5, pp. 559-577.
Klusewitz, G., & Rerick, R., (1996), "Constraint management through the drum-buffer-rope system," Paper presented at the IEEE/SEMI Advanced Semiconductor Manufacturing Conference.
Leach, L., (2003), "Schedule and cost buffer sizing: how to account for the bias between project performance and your model," Project Management Journal, Vol. 34, 2, pp. 34-47.
Lawton, R., & Parker, D., (2002), "Barriers to incident reporting in an health care system," Quality and Safety in Healthcare, Vol. 11, pp. 15-18.
Mahapatra, S. S., & Sahu, A., (2006, July 27-29), "Application of theory of constraints on scheduling of drum-buffer-rope system," Paper presented at the Proceedings of the International Conference on Global Manufacturing and Innovation, Coimbatore, India.
Marinagi, C. C., Spyropoulos, C. D., Papatheodorou, C., & Kokkotos, S., (2000), "Continual planning and scheduling for managing patient tests in hospital laboratories," Artificial Intelligence in Medicine, Vol. 20, 2, pp. 139-154.
Ogulata, S. N., Koyuncu, M., & Karakas, E., (2008), "Personnel and patient scheduling in the high demanded hospital services: a case study in the physiotherapy service," Journal of Medical Systems, Vol. 32, 3, pp. 221-228.
Project Management Institute,(2004), "A guide to the project management body of knowledge (PMBOK guide)", 3rd ed. Newtown Square, Project Management Institute, Inc.
Ramwadhdoebe, S., Buskens, E., Sakkers, R. J. B., & Stahl, J. E., (2009), "A tutorial on discrete-event simulation for health policy design and decision making: optimizing pediatric ultrasound screening for hip dysplasia as an illustration," Health Policy, Vol. 93, 2-3, pp. 143-150.
Rhee, S. H., Cho, N. W., & Bae, H., (2010), "Increasing the efficiency of business processes using a theory of constraints," Information Systems Frontiers, Vol. 12, 4, pp. 443-455.
Schragenheim, E., & Rozen, B., (1990), "Drum-Buffer-Rope Shop Floor Control," Production and Inventory Management Journal, Third Quarter, Vol. pp. 18-23.
Sivasubramanian, R., Selladurai, V. and Rajamramasamy, N., 2000, "The effect of the drum-buffer-rope (DBR) approach on performance of a synchronous manufacturing system (SMS), " Production Planning & Control, Vol. 11, 8, pp. 820-824
Steins, K., Persson, F., & Holmer, M., (2010), "Increasing utilization in a hospital operating department using simulation modeling," Simulation-Transactions of the Society for Modeling and Simulation International, Vol. 86, 8-9, pp. 463-480.
Steyn, H., (2002), "Project management applications of the theory of constraints beyond critical chain scheduling," International Journal of Project Management, Vol. 20, 1, pp. 75-80.
Tseng, M. F., & Wu, H. H., (2006), "The study of an easy-to-use DBR and BM system," International Journal of Production Research, Vol. 44, 8, pp. 1449-1478.
Tukel, O. I., Rom, W. O., & Eksioglu, S. D., (2006), "An investigation of buffer sizing techniques in critical chain scheduling," European Journal of Operational Research, Vol. 172, 2, pp. 401-416.
Umble, M., & Umble, E. J., (2006) "Utilizing buffer management to improve performance in a healthcare environment," European Journal of Operational Research, Vol. 174, pp. 1060-1075.
Vermeulen, I. B., Bohte, S. M., Elkhuizen, S. G., Lameris, H., Bakker, P. J. M., & La Poutre, H., (2009), "Adaptive resource allocation for efficient patient scheduling," Artificial Intelligence in Medicine, Vol. 46, 1, pp. 67-80.
Watson, K. J., Blackstone, J. H., & Gardiner, S. C., (2007), "The evolution of a management philosophy: The theory of constraints," Journal of Operations Management, Vol. 25, 2, pp. 387-402.
Wei, C.-C., Liu, P.-H., & Tsai, Y.-C., (2002), "Resource-constrainted project management using enhanced theory of constraint," International Journal of Project Management, Vol. 20, pp. 561-567.
Wu, H. H., & Liu, J. Y., (2008), "A capacity available-to-promise model for drum-buffer-rope systems," International Journal of Production Research, Vol. 46, 8, pp. 2255-2274.
Yang, M.-L., & Tsai, T.-C., (2008), "Enhancement of scheduling reliability in building project using theory of constraint," Journal of the Operations Research Society of Japan, Vol. 51, 4, pp. 284-298.
Ye, T., & Han, W., (2008), "Determination of buffer sizes for drum-buffer-rope (DBR)-controlled production systems," International Journal of Production Research, Vol. 46, 10, pp. 2827-2844.
Zhang, Y., Berman, O., Marcotte, P., & Verter, V., (2010), "A bilevel model for preventive healthcare facility network design with congestion," IIE Transactions, Vol. 42, 12, pp. 865-880.
網站部分
Landro, L., (2003). Hospitals encourage staff to report medical errors, Wall Street Journal Online, Retrieved March 25, from https://www.doctorquality.com/www/news/news_032503.htm
張鴻仁, (2004). 全民健保擴大服務讓成人預防保健臻於完善, 全民健康保險雙月刊第五十期, from http://www.nhi.gov.tw/webdata/webdata.asp?menu=6&menu_id=168&webdata_id=1448&WD_ID=
中央健保局, (2006). 認識「成人預防保健服務」的意義, from http://www.nhi.gov.tw/webdata/webdata.asp?menu=6&menu_id=168&webdata_id=1704&WD_ID
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