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系統識別號 U0026-3108202008084100
論文名稱(中文) 應用精實思維設計物理治療服務: 病患價值需求與服務收益的權衡
論文名稱(英文) Designing Physical Therapy Services with Lean Thinking: The Trade-Off Between Patient Needs and Service Profitability
校院名稱 成功大學
系所名稱(中) 工業設計學系
系所名稱(英) Department of Industrial Design
學年度 108
學期 2
出版年 109
研究生(中文) 陳美恩
研究生(英文) Mei-En Chen
學號 P36064077
學位類別 碩士
語文別 英文
論文頁數 119頁
口試委員 口試委員-楊大和
口試委員-洪宗乾
指導教授-洪郁修
口試委員-林彥呈
口試委員-楊政峰
中文關鍵字 精實思維  物理治療  病患需求  權衡  服務收益 
英文關鍵字 Lean  Physical therapy  Patient needs  Service profitability  Trade-off 
學科別分類
中文摘要 醫療資源有限且支出、需求持續上漲下,院方為了確保支出效益削減成本的做法難以兼顧病患需求。醫療服務應在支出效益保證與組織限制下滿足病患需求,以創造永續且獲利的醫療服務。精實管理雖能有效滿足服務收益與病患需求,然而在病患需求和滿意度的探討仍有不足。因此,本研究目的為應用精實思維權衡物理治療病患需求以及服務收益,設計物理治療服務。欲回答的研究問題為物理治療病患未被滿足需求以及服務後台限制為何?;精實思維如何權衡兩者?能否達到雙贏?本研究改善單位為臺灣某公立醫院的物理治療中心,主要服務收益來自門診健保服務,最大比例病患從骨科轉介。研究步驟分為六階段,第一,探索病患需求與營運現況;第二,發放病患需求問卷找出服務缺口,並分析服務流程;第三,以脈絡訪查紀錄大宗病患治療流程間的關鍵事件,再以訪談病患以及服務提供者找出服務缺口原因與後台限制;第四,在焦點團體中根據前階段結果權衡病患需求與服務收益,討論發展對策與設計提案;第五,物理治療服務流程與對策設計;第六,導入設計以及成效評估,比較介入前後服務收益、病患滿意度與員工滿意度。
結果發現5個病患需求,蒐集病患需求問卷有效問卷29份,服務缺口為「症狀可獲得妥善處理」、「治療後治療師衛教資訊完善」。並發現單位營運虧損且最大可控支出為人力成本,需提升生產力。脈絡訪查19位病患結果指出「症狀可獲得妥善處理」是因治療師處理排診問題以及等待空間設備而中斷治療。「治療後治療師衛教資訊完善」是因治療間隔太長,病患需要回家自行運動。經9次焦點團體討論鎖定三大議題改善,在 12次對策擬定會議中設計預約排診系統,功能包括:提供行政人員排診資訊、排診錯開空間設備、提供病患排診間隔資訊,另外也擬定對策減少生產力耗損。系統啟用後三個月,每天增加3~5人次,單月收入成長13%,病患介入前滿意度4.3顯著大於介入後病患滿意度4.6。結果指出精實思維以病患需求拉動以設計物理治療服務,能在不犧牲員工前提下對病患端與營運端產生正面效果。
英文摘要 As medical resources are limited and expenditures and demand continue to rise, medical services should meet the needs of patients under the guarantee of expenditure benefits to create sustainable and profitable medical services. Therefore, the purpose of this study is to use lean thinking to weigh the needs of physical therapy patients and service benefits and to design physical therapy services. The improvement unit of this study is a physical therapy center of a public hospital in Taiwan. First, explore patient needs and operating conditions. Second, issue patient demand questionnaires to identify service gaps. Third, use contextual inquiry to discover the treatment process of patients. Then, interview patients and service providers to find out the reasons for service gaps and back-end restrictions. Fourth, weigh patient needs and service benefits in focus groups, and discuss development strategies. Fifth, physical therapy service process and countermeasure design. Sixth, import design and effectiveness evaluation, compare service income, patient satisfaction, and employee satisfaction before and after the intervention.
The results show the service gaps were "symptoms can be handled properly" and "therapist health education information is perfect after treatment." Moreover, found that the unit's operating losses and the largest controllable expenditure are the labor cost, which needs to increase productivity. The results of the contextual inquiry indicated that because the therapist handled the scheduling problem and waited for the space equipment to interrupt the treatment. Also, because the treatment interval is too long, and the patient needs to go home and exercise by himself. After focus group discussions, the appointment scheduling system was designed. The functions include: providing scheduling information, scheduling appointment diverting space and equipment, providing patient scheduling interval information. Three months after the system was launched, the number of people increased by 3~5 per day, and the monthly income increased by 13%. Patient satisfaction before the intervention was significantly greater than after intervention. The results point out that design physical therapy services with lean thinking, which is driven by patients' needs, can have a positive effect on the patients and service profitability.
論文目次 摘要 ii
SUMMARY iii
ACKNOWLEDGEMENTS iv
TABLE OF CONTENTS v
LIST OF TABLES viii
LIST OF FIGURES ix
LIST OF ABBREVIATIONS xi
CHAPTER 1 INTRODUCTION 1
1.1 Background and Motivation 1
1.2 Research Purpose 6
1.3 Research Contribution 7
1.3.1 Academic 7
1.3.2 Practice 8
CHAPTER 2 Literature Review 10
2.1 Medical Services Applied Lean Thinking 10
2.1.1 Lean Thinking 10
2.1.2 Results of Medical Researches Applied Lean Thinking 11
2.1.3 Limitation of Medical Services Applied Lean Thinking 13
2.1.4 Summary 15
2.2 Explore the Needs of Physical Therapy Patient 16
2.2.1 Studies Discuss on the Needs of Physical Therapy Patient 16
2.2.2 Summary 18
2.3 Trade-Offs and Limitation of Patient Needs and Service Profitability 18
2.3.1 Patient Needs Contradict with Service Profitability 19
2.3.2 Trade-Offs Between Patient Needs and Service Profitability 19
2.3.3 Summary 21
CHAPTER 3 Methodology 22
3.1 Case Introduction 22
3.2 Research Process 25
3.3 Targeting the Scope of Improvement: Patient Needs and Operations 27
3.3.1 Explore Patient's Needs 27
3.3.2 Clarify Operation Status 28
3.4 Current Situation Investigation: Patient Needs Survey and Task Analysis 28
3.4.1 Participants 29
3.4.2 Questionnaire Design 29
3.4.3 Data Aanalysis 30
3.4.4 Service Task Analysis 31
3.5 Contextual Inquiry: Value Stream Mapping 32
3.5.1 Participants 32
3.5.2 Equipments 35
3.5.3 Research Steps 37
3.5.4 Data Analysis 38
3.6 Focus Group: Trade-Offs Between Patients’ Needs and Profit 41
3.6.1 Participants 41
3.6.2 Research Steps 41
3.7 Redesign Physical Therapy Services 44
3.7.1 Research Steps 44
3.8 Implementation of the Design and Evaluation of the Effectiveness 45
3.8.1 Participants 45
3.8.2 Research Steps 46
3.8.3 Data Analysis 46
CHAPTER 4 Results 48
4.1 Targeting the Scope of Improvement: Patient Needs and Operations 48
4.1.1 Explore Patient's Needs 48
4.1.2 Clarify Operation Status 49
4.2 Current Situation Investigation: Patient Needs Survey and Task Analysis 52
4.2.1 Patient Needs Survey 52
4.2.2 Service Task Analysis 56
4.3 Contextual Inquiry: Value Stream Mapping 61
4.3.1 Symptoms Can be Handled Appropriately 63
4.3.2 The Therapist Gives Sufficient Health Education Information 65
4.3.3 Service Gap Root Cause 66
4.4 Focus Group: Trade-Offs Between Patients’ Needs and Profit 69
4.4.1 Problem and Topic Discussion 69
4.4.2 Trade-off countermeasure and countermeasure weight evaluation 71
4.5 Redesign Physical Therapy Services 77
4.5.1 Design Prototype 77
4.5.2 Countermeasures and Actual Improvements 82
4.6 Implementation of the Design and Evaluation of the Effectiveness 86
4.6.1 Implemented Service Design Problem Correction 87
4.6.2 Performance Tracking and Verification 87
CHAPTER 5 Discussion 99
5.1 Improvements of Trade-Offs Between Patient Needs and Service Benefits 99
5.2 The Method of Implementing Lean Thinking 100
5.3 The Trade-Offs Through Lean Thinking 101
5.4 Effectiveness of the introduction of lean thinking 101
CHAPTER 6 Conclusions 103
6.1 Research Contribution 103
6.2 Research Limitations and Recommendations 104
6.2.1 Method and Strategies 104
6.2.2 People and Staff 105
6.2.3 Results and Effectiveness 106
REFERENCES 107
Appendix A A Early service quality questionnaire survey and results 114
Appendix B Patient Value Needs Questionnaire 117
Appendix C Task analysis results 118
Appendix D Treatment process of patients in CONTEXTUAL INQUIRY 119

參考文獻 1. Antierens, A., Beeckman, D., Verhaeghe, S., Myny, D., & Van Hecke, A. (2018). How much of Toyota's philosophy is embedded in health care at the organisational level? A review. Journal of nursing management.
2. Beattie, P. F., & Nelson, R. M. (2008). Preserving the quality of the patient-therapist relationship: an important consideration for value-centered physical therapy care. In: JOSPT, Inc. JOSPT, 1033 North Fairfax Street, Suite 304, Alexandria, VA ….
3. Beattie, P. F., Pinto, M. B., Nelson, M. K., & Nelson, R. (2002). Patient satisfaction with outpatient physical therapy: instrument validation. Physical therapy, 82(6), 557-565.
4. Bechel, D. L., Myers, W. A., & Smith, D. G. (2000). Does patient-centered care pay off? The Joint Commission journal on quality improvement, 26(7), 400-409.
5. Belter, D., Halsey, J., Severtson, H., Fix, A., Michelfelder, L., Michalak, K., . . . De Ianni, A. (2012). Evaluation of outpatient oncology services using lean methodology. Paper presented at the Oncology nursing forum.
6. Bleustein, C., Rothschild, D. B., Valen, A., Valatis, E., Schweitzer, L., & Jones, R. (2014). Wait times, patient satisfaction scores, and the perception of care. The American journal of managed care, 20(5), 393-400.
7. Boak, G., Sephton, R., Hough, E., & ten Hove, R. (2017). Quality improvement in physiotherapy services. International journal of health care quality assurance, 30(5), 424-435.
8. Bowen, S., McSeveny, K., Lockley, E., Wolstenholme, D., Cobb, M., & Dearden, A. (2013). How was it for you? Experiences of participatory design in the UK health service. CoDesign, 9(4), 230-246.
9. Calabrese, A. (2012). Service productivity and service quality: A necessary trade-off? International Journal of Production Economics, 135(2), 800-812.
10. Carlborg, P., Kindström, D., & Kowalkowski, C. (2013). A lean approach for service productivity improvements: synergy or oxymoron? Managing Service Quality: An International Journal, 23(4), 291-304.
11. Charmel, P., & Frampton, S. B. (2008). Building the business case for patient-centered care. Healthcare Financial Management, 62(3), 80-85.
12. Cosgrove, D. M., Fisher, M., Gabow, P., Gottlieb, G., Halvorson, G. C., James, B. C., . . . Steele, G. D. (2013). Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs. Health affairs, 32(2), 321-327.
13. Dagger, T. S., Sweeney, J. C., & Johnson, L. W. (2007). A hierarchical model of health service quality: scale development and investigation of an integrated model. Journal of service research, 10(2), 123-142.
14. de Souza, S., Galloway, J., Simpson, C., Chura, R., Dobson, J., Gullick, N. J., . . . Lempp, H. (2017). Patient involvement in rheumatology outpatient service design and delivery: a case study. Health Expect, 20(3), 508-518. doi:10.1111/hex.12478
15. Del Baño-Aledo, M. E., Medina-Mirapeix, F., Escolar-Reina, P., Montilla-Herrador, J., & Collins, S. M. (2014). Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study. Physiotherapy, 100(1), 73-79.
16. Deslauriers, S., Raymond, M.-H., Laliberté, M., Lavoie, A., Desmeules, F., Feldman, D. E., & Perreault, K. (2017). Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disability and rehabilitation, 39(26), 2648-2656.
17. Doğan, N. Ö., & Unutulmaz, O. (2014). Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital. Total Quality Management & Business Excellence, 27(1-2), 64-80. doi:10.1080/14783363.2014.945312
18. Dunsford, J., & Reimer, L. E. (2017). Relationship-centered health care as a Lean intervention. International Journal for Quality in Health Care, 29(8), 1020-1024.
19. Duska, L. R., Mueller, J., Lothamer, H., Pelkofski, E. B., & Novicoff, W. M. (2015). Lean methodology improves efficiency in outpatient academic Gynecologic Oncology clinics. Gynecol Oncol, 138(3), 707-711. doi:10.1016/j.ygyno.2015.07.001
20. Frei, F. X. (2006). Breaking the trade-off between efficiency and service. Harvard business review, 84(11), 92.
21. Goldstein, M. S., Elliott, S. D., & Guccione, A. A. (2000). The development of an instrument to measure satisfaction with physical therapy. Physical therapy, 80(9), 853-863.
22. Heskett, J. L., Jones, T. O., Loveman, G. W., Sasser, W. E., & Schlesinger, L. A. (1994). Putting the service-profit chain to work. Harvard business review, 72(2), 164-174.
23. Hills, R., & Kitchen, S. (2007). Toward a theory of patient satisfaction with physiotherapy: Exploring the concept of satisfaction. Physiotherapy theory and practice, 23(5), 243-254.
24. Huang, X.-M. (1994). Patient attitude towards waiting in an outpatient clinic and its applications. Health Services Management Research, 7(1), 2-8.
25. Huddle, M. G., Tirabassi, A., Turner, L., Lee, E., Ries, K., & Lin, S. Y. (2016). Application of Lean Sigma to the Audiology Clinic at a Large Academic Center. Otolaryngol Head Neck Surg, 154(4), 715-719. doi:10.1177/0194599815627774
26. Jayasinha, Y. (2016). Decreasing Turnaround Time and Increasing Patient Satisfaction in a Safety Net Hospital-Based Pediatrics Clinic Using Lean Six Sigma Methodologies. Qual Manag Health Care, 25(1), 38-43. doi:10.1097/QMH.0000000000000083
27. Jette, A. M., & Delitto, A. (1997). Physical therapy treatment choices for musculoskeletal impairments. Physical therapy, 77(2), 145-154.
28. Keith, R. A. (1998). Patient satisfaction and rehabilitation services. Archives of physical medicine and rehabilitation, 79(9), 1122-1128.
29. Laliberté, M., E. Feldman, D., Williams-Jones, B., & Hunt, M. (2018). Operationalizing wait lists: Strategies and experiences in three hospital outpatient physiotherapy departments in Montreal. Physiotherapy theory and practice, 34(11), 872-881.
30. Leddy, K. M., Kaldenberg, D. O., & Becker, B. W. (2003). Timeliness in ambulatory care treatment: an examination of patient satisfaction and wait times in medical practices and outpatient test and treatment facilities. The Journal of ambulatory care management, 26(2), 138-149.
31. Levesque, J., Bogoch, E. R., Cooney, B., Johnston, B., & Wright, J. G. (2000). Improving patient satisfaction with time spent in an orthopedic outpatient clinic. Canadian Journal of Surgery, 43(6), 431.
32. Liker, J. (2004). The Toyota Way: 14 management principles from the world’s
33. greatest manufacturer. New York: McGraw-Hill.
34. Lin, M., Heisler, S., Fahey, L., McGinnis, J., & Whiffen, T. L. (2015). Nurse Knowledge ExchangePlus: Human-Centered Implementation for Spread and Sustainability. The Joint Commission Journal on Quality and Patient Safety, 41(7), 303-AP305.
35. Lin, S. Y., Gavney, D., Ishman, S. L., & Cady-Reh, J. (2013). Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency. Laryngoscope, 123(11), 2643-2648. doi:10.1002/lary.24110
36. Lindsay, R., Hanson, L., Taylor, M., & McBurney, H. (2008). Workplace stressors experienced by physiotherapists working in regional public hospitals. Australian Journal of Rural Health, 16(4), 194-200.
37. Ly, D. P., & Cutler, D. M. (2018). Factors of US hospitals associated with improved profit margins: An observational study. Journal of general internal medicine, 1-8.
38. Makarem, S. C., & Al-Amin, M. (2014). Beyond the service process: The effects of organizational and market factors on customer perceptions of health care services. Journal of Service Research, 17(4), 399-414.
39. McDermott, A. M., Kidd, P., Gately, M., Casey, R., Burke, H., O'Donnell, P., . . . O'Brien, T. (2013). Restructuring of the Diabetes Day Centre: a pilot lean project in a tertiary referral centre in the West of Ireland. BMJ Qual Saf, 22(8), 681-688. doi:10.1136/bmjqs-2012-001676
40. McIntosh, B., Sheppy, B., & Cohen, I. (2014). Illusion or delusion–Lean management in the health sector. International journal of health care quality assurance, 27(6), 482-492.
41. Melanson, S. E., Goonan, E. M., Lobo, M. M., Baum, J. M., Paredes, J. D., Santos, K. S., . . . Tanasijevic, M. J. (2009). Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow. Am J Clin Pathol, 132(6), 914-919. doi:10.1309/AJCP7FIKZVVTFTXQ
42. Moraros, J., Lemstra, M., & Nwankwo, C. (2016). Lean interventions in healthcare: do they actually work? A systematic literature review. International Journal for Quality in Health Care, 28(2), 150-165.
43. Mulgan, G. (2014). Design in public and social innovation: what works and what could work better. Retrieved, 23(07), 2015.
44. Nielsen, J. (1994). Usability engineering: Elsevier.
45. Ohno, T. (1988). Toyota production system: beyond large-scale production: crc Press.
46. Pascoe, G. C. (1983). Patient satisfaction in primary health care: a literature review and analysis. Evaluation and program planning, 6(3-4), 185-210.
47. Peersman, W., Rooms, T., Bracke, N., Van Waelvelde, H., De Maeseneer, J., & Cambier, D. (2013). Patients' priorities regarding outpatient physiotherapy care: a qualitative and quantitative study. Manual therapy, 18(2), 155-164.
48. Pine, B. J., & Gilmore, J. H. (1998). Welcome to the experience economy. Harvard business review, 76, 97-105.
49. Pine, B. J., & Gilmore, J. H. (2011). The experience economy: Harvard Business Press.
50. Richards, K. A., & Jones, E. (2008). Customer relationship management: Finding value drivers. Industrial marketing management, 37(2), 120-130.
51. Richter, J. P., & Muhlestein, D. B. (2017). Patient experience and hospital profitability: Is there a link? Health care management review, 42(3), 247-257.
52. Roush, S. E., & Sonstroem, R. J. (1999). Development of the physical therapy outpatient satisfaction survey (PTOPS). Physical therapy, 79(2), 159-170.
53. Sethi, R., Yanamadala, V., Burton, D. C., & Bess, R. S. (2017). Using lean process improvement to enhance safety and value in orthopaedic surgery: the case of spine surgery. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 25(11), e244-e250.
54. Shortell, S. M., Blodgett, J. C., Rundall, T. G., & Kralovec, P. (2018). Use of Lean and Related Transformational Performance Improvement Systems in Hospitals in the United States: Results From a National Survey. Joint Commission Journal on Quality and Patient Safety.
55. Simons, P., Backes, H., Bergs, J., Emans, D., Johannesma, M., Jacobs, M., . . . Vandijck, D. (2017). The effects of a lean transition on process times, patients and employees. International journal of health care quality assurance, 30(2), 103-118.
56. Smith, M., Paton, S., & MacBryde, J. (2018). Lean implementation in a service factory: views from the front-line. Production Planning & Control, 29(4), 280-288.
57. Storfjell, J. L., Omoike, O., & Ohlson, S. (2008). The balancing act: patient care time versus cost. Journal of nursing administration, 38(5), 244-249.
58. Sullivan, P., Soefje, S., Reinhart, D., McGeary, C., & Cabie, E. D. (2014). Using lean methodology to improve productivity in a hospital oncology pharmacy. Am J Health Syst Pharm, 71(17), 1491-1498. doi:10.2146/ajhp130436
59. Tlapa, D., Zepeda-Lugo, C. A., Tortorella, G. L., Baez-Lopez, Y. A., Limon-Romero, J., Alvarado-Iniesta, A., & Rodriguez-Borbon, M. I. (2020). Effects of Lean Healthcare on Patient Flow: A Systematic Review. Value in Health.
60. Toussaint, J., Gerard, R. A., & Adams, E. (2010). On the mend. Cambridge (MA): Lean Enterprise Institute, 181.
61. Tsianakas, V., Robert, G., Maben, J., Richardson, A., Dale, C., & Wiseman, T. (2012). Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services. Supportive care in cancer, 20(11), 2639-2647.
62. Ulwick, A. W. (2016). Jobs to be done: theory to practice: Idea Bite Press.
63. van Leijen‐Zeelenberg, J. E., Brunings, J. W., Houkes, I., van Raak, A. J., Ruwaard, D., Vrijhoef, H. J., & Kremer, B. (2016). Using Lean Thinking at an otorhinolaryngology outpatient clinic to improve quality of care. The Laryngoscope, 126(4), 839-846.
64. WHO. (2017). New Perspectives on Global Health Spending for Universal Health Coverage. Retrieved from
65. Womack, J. P., & Jones, D. T. (1997). Lean thinking—banish waste and create wealth in your corporation. Journal of the Operational Research Society, 48(11), 1148-1148.
66. Womack, J. P., Jones, D. T., & Roos, D. (1990). Machine that changed the world: Simon and Schuster.
67. Woolf, A. D., & Pfleger, B. (2003). Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81, 646-656.
68. Ye, J., Dong, B., & Lee, J.-Y. (2017). The long-term impact of service empathy and responsiveness on customer satisfaction and profitability: a longitudinal investigation in a healthcare context. Marketing Letters, 28(4), 551-564.

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