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
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 
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
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
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

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