應用多準則決策法以改善台灣老年病患門診服務｜國立臺灣科技大學博碩士論文系統

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研究生：	吳永宏 Yung-hung Wu
論文名稱：	應用多準則決策法以改善台灣老年病患門診服務 Application of MCDM method to improve outpatient services for elderly patients in Taiwan
指導教授：	郭人介 Ren-jieh Kuo 許總欣 Tsung-shin Hsu
口試委員:	廖慶榮 Ching-jong Liao 林恆慶 Herng-ching Lin 鍾國彪 Kuo-piao Chung 陳亮恭 Liang-kung Chen
學位類別：	博士 Doctor
系所名稱：	管理學院 - 工業管理系 Department of Industrial Management
論文出版年：	2012
畢業學年度：	100
語文別：	英文
論文頁數：	86
中文關鍵詞：	高齡化社會、品質機能展開、醫療照護失效模式與效應分析、二維品質模式、模糊理論、多準則決策方法
外文關鍵詞：	Aged society, QFD (Quality Function Deployment), HFMEA (Healthcare Failure Mode and Effects Analy, Kano’s model, Fuzzy theory, MCDM (Multi-Criteria Decision-Making)
相關次數：	點閱：363 下載：8
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人口老化已是全球關注的一個焦點，而台灣地區老年人口所佔的比例已超過10%，早已達聯合國世界衛生組織所以定義的高齡化社會，若以老年人口的成長速度來看，高居世界第二位。人口老化的比率及速度快速成長，相對的也反映出老年病患醫療的重要性和急迫性與日俱增，醫療院所必須重新思考如何提供符合老人需求的門診需求品質項目，以營造友善的就醫環境。品質機能展開，經過四十多年的開發與應用，已被證明為一有效縮短研發時間、降低成本及掌握顧客需求的工具，而醫療照護失效模式與效應分析為美國國家病人安全中心發展出來做為有效改善病患就醫流程的方法，這兩種方法有其優點，但也有其不足之處。因此，本研究嘗試應用二維品質模式、模糊理論，並結合多準則決策方法來加以改善。研究發現，老年病患重視的門診需求品質項目前三項依序為「有符合病患使用的醫療機器設備」、「提供迅速的服務解決病患問題」、「主動為病患提供服務」，而必須改善的門診作業失效模式依序為「看診時間太短」、「未告知檢查或治療可能產生的併發症」、「及未尊重病患和家屬的想法和感覺」。本研究除針對上述失效模式提出改善建議外，其發展出的改善老年病患門診服務作業模式也可擴展至其他醫療的作業流程，並提供給所有醫療院所參考。

Population aging has become one of the major global health issues (WHO, 1999). The overall senior population in Taiwan has surpassed 10%, meeting the WHO definition of an aged society. In terms of aging rate, Taiwan ranks second among societies worldwide. This significant growth in elderly population also reflects the importance of the emergence and development of geriatric medical care. Given these demographic trends, hospitals should reconsider how to provide suitable outpatient service for elderly patients and create an aging-friendly environment. Through more than 40 years of application, QFD (Quality Function Deployment) has been proven to be an effective tool to shorten research-and-development cycles, reduce costs, and meet customer’s needs. HFMEA (Healthcare Failure Mode and Effects Analysis), first introduced by NCPS, is a method to improve medical care processes. There are pros and cons with each of these two methods, so an optimized modified version will be deployed by applying Kano’s model, Fuzzy theory and MCDM (Multi-Criteria Decision-Making). The research found that the key QRs (Quality Requirements) in order of importance were ‘Proper medical equipment for patients’, ‘Providing fast services to solve patients’ problems’, and ‘patient-centered service’. Also, the modes needing improvement were “The clinical examination is too brief,” “insufficient disclosure of possible complications from the treatment” and “Opinions and feelings of the patient and relatives are not respected.” Based on these findings, we conclude by recommending an operational model for geriatric outpatient service that we hope can also serve as a useful clinical reference.

中文摘要.........................................................................................................................	i
ABSTRACT	ii
致謝...............................................................................................................................	iv
CONTENTS	vi
LIST OF FIGURES	x
LIST OF TABLES	xi
Chapter 1 INTRODUCTION	1
1.	Background	1
2.	Motivation	2
3.	Research Objectives	4
4.	Research Process	5
Chapter 2 LITERATURE REVIEW	7
1.	Quality of Medical Care Service	7
2.	Kano’s Model	9
3.	Fuzzy Set Theory	12
3.1.	Membership Function	12
3.2.	Positive Triangular Fuzzy Number（PTFN）	12
3.3.	α-Cut	13
3.4.	Linguistic Variable and Fuzzification	14
3.5.	Defuzzification	15
4.	Quality Function Deployment (QFD)	16
5.	Multi-Criteria Decision-Making (MCDM)	18
5.1.	Analytic Network Process (ANP)	18
5.2.	Technique for Order Preference by Similarity to Ideal Solution (TOPSIS)	20
6.	Healthcare Failure Mode and Effects Analysis (HFMEA)	21
Chapter 3 RESEARCH METHOD	23
1.	Research Structure	23
2.	KANO’s Model	25
3.	Integrate Fuzzy ANP with QFD	27
3.1.	Construct the Network of ANP	27
3.2.	Paired Comparison Matrix and Relative Weights	28
3.3.	Construct the House of Quality of Supermatrix Structure	28
4.	Integrate Fuzzy TOPSIS and HFMEA	29
4.1.	Define the HFMEA Topic	29
4.2.	Assemble the Team	30
4.3.	Graphically Describe the Process	30
4.4.	Conduct a Hazard Analysis	32
4.5.	Actions and Measures	37
Chapter 4 RESEARCH RUSULTS	39
1.	QRs of Geriatric Outpatient Service	39
2.	Integrate Fuzzy ANP and QFD	43
2.1.	QRs and OCs in Geriatric Outpatient Service	43
2.2.	Network of ANP	45
2.3.	Integrate Questionnaire with Fuzzy ANP	45
3.	Construct HoQ for Geriatric Outpatient Service	47
4.	Integrate Fuzzy TOPSIS and HFMEA	50
4.1.	Process of Geriatric Outpatient Service	50
4.2.	Selecting and Rating the Failure Modes	50
4.3.	Risk Ranking of the Failure Modes	55
4.4.	Developing Actions and Measurement	56
Chapter 5 DISCUSSION	58
1.	Reliability of questionnaire	58
2.	Actions and Measures	58
3.	Research Limitation	59
Chapter 6 CONCLUSIONS AND FUTURE STUDIES	61
1.	Conclusions	61
2.	Future Studies	63
REFERENCES	64
Appendix A. Questionnaire Applied of Kano’s Model	70
Appendix B. Expert Questionnaire Applied of ANP	73

                                

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