| 摘要: | 由於全民健保財務緊縮，於民國九十一年七月一日開始實施總額預算制度，嚴格限制醫療費用的成長幅度，造成醫院收入相對持續性貶值，加上大幅降低藥價申報費用，嚴重壓縮醫院經營的利潤空間，也嚴重威脅競爭力相對弱勢的非營利公立醫院的生存。
另一方面衛生署對醫院醫療品質（內部流程面）、醫病關係（顧客面）、教育研究品質（學習成長面），則以醫院評鑑方式來督促醫院對這三方面的重視，相對不斷增加醫院的經營成本。因此，劃時代的平衡計分卡所強調的四個構面的因果關係與平衡關係，就成為醫院經營者要在這四個構面之間尋求平衡點，最完美契合的管理工具。
本研究方法藉著個案醫院改制，醫院領導者推動策略地圖與平衡計分卡進行醫院策略管理與組織改造，個人藉實際參與整個過程來深入本研究如何將院層級策略地圖與平衡計分卡順利推展至部門層級。包括利用讀書會認識策略地圖，建立部門願景使命；進行部門內外環境分析發展策略理論；制定並撰畫部門策略地圖；最後展開部門平衡計分卡。
個案醫院外科部實施平衡計分卡成功的經驗在於有高層領導全力支持、部門主管的學習經驗、部門專案團隊的組成、部門為學習型組織、訓練與資訊的傳遞、制定以組織願景及策略為基礎的平衡計分卡。由學習成長加強專業能力，改善工作流程，降低成本，提升服務品質，增加顧客滿意度，使外科部蓬勃發展。部門層級所碰到的困難包括承接院層級的衡量目標值是如何區分短期與長期目標及有些行動方案是部門層級無法獨立完成的。
策略地圖與平衡計分卡不是靜態的圖表，而是動態持續的計畫、執行、檢核、行動的循環（PDCA cycle），策略制定、執行、檢測、策略校準、再執行、再檢測，是一個不斷的循環。導入策略地圖與平衡計分卡不可短視，要有耐心，醫院領導者利用此工具在進行組織不斷的變革。由學習成長面形成學習型組織，累積智慧資本，強化核心能力。組織文化的改變要反應於績效不是短時間看得出來。策略地圖與平衡計分卡的好處在於它是一種策略管理工具，可將策略與日常管理（包括目標管理）全部呈現在計分卡上，團隊有共同溝通的語言，如同人體的神經系統，由大腦指揮五官四肢，策略指出正確的方向（卓越的領導），衡量指標確定行動方案並落實行動方案將事情做對，願景使命才得以實現。組織才能產生飛輪效應，由優越至卓越。
Because of the financial deflation of the National Health Insurance, the BNHI (Bureau of National Health Insurance) started to implement the global budget payment system to curb the growth of medical expenses and balance the financial deficiency, on July 1, 2002. It made the financial decrease of the hospital income continuously. In addition, the reduction of the insurance pay of drug, the profit of hospital management was deflated severely. For the disadvantaged minority relatively, the survival of the public hospitals is more critical.
The Department of Health (DOH) pays much attention to the quality of medical care (the business process perspective), the relationship of physician-patient (the customer perspective), the quality of the education and study (the growth and learning perspective). So, the DOH makes the use of hospital accreditation to push all hospital to respect the three perspectives. However, this will increase the cost of hospital finance. The balanced scorecard approach provides a clear prescription as to what companies should measure in order to ''balance'' the financial perspective. It will be a perfect system for the hospital manager to look for the balance point of the four perspectives.
By the change of the system of the case hospital, the superintendent introduced the map strategy and balanced scored into the hospital for the management of strategy and the recreation of the organization. I attend the whole process and study how to push the map strategy and balanced scorecard from the corporate level to the department level. By the learning group, all members knew what strategy map and balanced scorecard was, and set the vision and mission of the surgical department. By the structural analysis, the theory of strategy was developed. The strategy map and balanced scorecard was set up.
The successful experience of applying BSC at the surgical department of studied hospital relied on the strong support the leader of the hospital, the learning experience of the director of the department, the team work of the project, learning-type department, communication of training and information, setting the BSC based on the vision and strategy. By learning and growth, the professional ability was strengthened, then the internal process was improved, the cost was decreased, the service quality was improved and the patient’s satisfaction is elevated. At last, the performance of the surgical department developed.
The straits faced by the surgical department included how to distinguish the short-term and long-term objectives when setting the measurement and some action plans could not be completed by the deparment alone.
The strategy map and balanced scorecard is not only a static card, but a dynamic one as the cycle of PDCA (plan, do, check, action). The constitution, execution, check, alignment, re-execution and recheck of strategy is a continuous cycle. The hospital becomes the learning-type organization by the growth and learning perspective to increase the knowledge capital assets and enhance the core ability. The financial growth from the cultural change is slow. The strategy map and balanced scorecard is an instrument of strategic management. There is a common language of the team with good communication, just as the human neurological system. The strategy indicates the right direction and the measures and action plans express “doing the thing right’. The organization can generate the effect of fly wheel and be from good to excellent. |
