| Abstract: | 政府自民國84年開始實施全民健保，國人因此享有安全又便利的醫療服務，此成就讓台灣的全民健保制度在國際間獲得高度肯定。長期以來，由於台灣因受人口老化，科技進步，民眾健康需求增加之影響，健保的財務狀況均處於失衡狀態。為緊縮健保醫療預算，健保局自民國91年實施總額支付制度，各醫院的醫療收入成長受限，各個類型醫院都面對經營益形困難的困境。本個案醫院為醫學中心，為改善營運，早於93年就推動過平衡計分卡制度，惟當時成效並未彰顯；在民國97年，個案醫院經營管理階層認為平衡計分卡可具體協助醫院建構策略型組織，進而引導變革促使組織蛻變成長，適存於現今競爭激烈的醫療市場，因此重新啟動此管理工具。本研究採個案研究法，分別透過整理文件檔案紀錄與直接現場觀察收集資料，比較二次推動過平衡計分卡制度的差異，並探討其成敗原因。 本研究發現，第一次推動平衡計分卡制度的失敗是設定之KPI（關鍵績效指標）與醫院策略目標無因果關係與相關連結，且在執行步驟與與事前準備等作業環節上出了差錯。由於有過去失敗的經驗，讓個案醫院在第二次推動平衡計分卡制度時，大幅度的修正與調整實施方法與執行步驟，諸如推動的層級、作業的範疇、專家的引領、策略的運作模式、資訊系統的建置以及明確具體的執行步驟（規劃準備、共識形成、策略釐清、執行控管)因此得到顯著的施行成效。個案醫院推動平衡計分卡從失敗、修正、改善到成功的獨特經驗，深具其他醫院於導入與執行平衡計分卡之參考價值。 此外，本研究發現第二次推動平衡計分卡制度，除施行的範圍與手法異於第一次外，其關鍵成功因素包括全員參與、首長支持、顧問團隊引導、回饋機制等，尤其是在準備階段，醫院先行培養與塑造學習型組織氛圍，激勵員工自發性變革的強烈意願，強化員工對組織共同願景的追求，奠定了平衡計分卡制度推動成功的基石。 第三，本研究發現個案醫院於第二次推動平衡計分卡時，修改了架構將策略地圖中之財務構面，由第一次推動之最上層移至最底層，並將顧客構面移至最上層凸顯醫院之經營係以病人為中心，講求醫病關係之確保，顯現非營利組織營運之特性。 第四，個案醫院在導入平衡計分卡的過程中，也同時帶動了組織其它營運管理活動，諸如作業基礎成本制度(Activity-Based Costing, ABC)之建構與推動、經營管理儀表板(Dashboard)建置及醫療服務流程改善、精實醫療管理(Lean)活動之推展，將許多管理活動納入平衡計分卡系統，逐漸完成醫院整合性績效管理平台。 第五，個案醫院第二次推動平衡計分卡是以策略主題為主軸，如此不僅可以將有限的資源做最有效的投資，更可將策略聚焦；為具體落實策略，院級關鍵績效指標下展至各級單位(行政單位一級、醫療單位二級)時，從六大策略主題出發，針對院級KPI訂定相關承接部門，承接部科之策略地圖、關鍵績效指標與行動方案必須與醫院之願景與策略目標相互連結。相關部門除必需承接院級策略目標展開其策略地圖與行動方案外，並可在不違背醫院總體營運策略方向下依據部科特性發展自身關鍵績效指標，如此，各部科與醫院總體策略目標不僅趨於一致外，還可依部科發展特性彈性運作，一同朝醫院願景邁進。 個案醫院推動平衡計分卡，從管理工具的評估、預算的籌措、制度的推動與運作，會計人員無役不與，積極扮演特業幕僚角色功能。研究者以為組織在推動變革或導入新的管理工具時，會計部門的支持與參與極其重要，特別是會計主管更應以身作則，帶領團隊積極投入。研究者身為醫院會計主任，於平衡計分卡作業活動中擔任「經營績效最佳化」負責人，參與決策階層策略委員會運作。於會中提出之具體建議，均獲得領導階層高度肯定與採納，諸如機動參與或退出「點值穩定方案」策略、策略預算制度之建立、ABC作業基礎成本管理制度之推動等。從個案醫院近幾年營運績效優異之表現觀之，平衡計分卡確實已發揮了預期的功能。醫院在施行平衡計分卡之過程中，會計部門確實已扮演了積極且重要的角色。對整體制度之推動作出了具體之貢獻，也提升了會計部門在組織中的功能與價值。
Since National Health Insurance was instituted in Taiwan in 1995, people were entitled to have safe and convenient medical services. This measure is highly approved among nations. The finance of Health Insurance has been long-term unbalanced as a result of aging population, advances in technology, and increasing health needs of the public. In order to reduce the medical budget for Health Insurance, NHI established Global Budget Payment System since 2002, after that, hospitals had more and more difficulties in running business and medical centers faced the same problem as well. The hospital made was trying to improve operations and promoted Balance Scorecard System in 2004 but only reflected a little unobvious effect then. In 2008, the business supervisors still believed that Balance Scorecard can indeed help the hospital to construct strategic organization. Furthermore, it will lead a revolution in transformation and growth of the organization. The truth is it is absolutely exists in the competitive medical market. Therefore restart this management appliance. The design of this study is case study. The researcher occupies a project director for the topic of “Management Achievement optimization”, whose duty is fully participating in Balance Scorecard implement and promotion, data collection of documents, records and observation. One of the discoveries of this study: The first failure is the balanced scorecard system setting of KPIs (key performance indicators) and no causal relationship with the relevant links to the hospital strategic goals. Substantial amendments and adjustments to the implementation of the method steps, such as to promote the level, scope, expert guidance, the mode of operation, information systems, and clear and specific steps (planning and preparation, the formation of a consensus, strategy defined, executive control) To get the remarkable effectiveness of the implementation. The case hospital to promote the balanced scorecard from failure, correction, improvement to the success of the unique experience of deep other hospitals in the reference value for the introduction and implementation of the Balanced Scorecard. The second discovery of this study: the differences in applying range and in executing method in the second promotion. The essential successful factors, such as entirely participation, the support of chiefs, the guidance of consultant group, feedback scheme, throughout the operating process. Especially during the period of arrangement, the hospital developed and built up a learning atmosphere in advance, inspired staffs a strong will to spontaneously reform, strengthened an aspiration for the common prospect. It consolidated the introduction of Balance Scorecard System and gave fresh impetus to success. The third discovery: the hospital revised the construction of Balance Scorecard. In the first promotion, financial aspect was in the highest layer but moved to the lowest in the second promotion. In addition, the customer aspect was moved to the highest layer which manifested that the hospital management took patient-centered for primary and doctor-patient relationship guarantee. Also, it showed the feature of non-profit institution. The fourth discovery: the process of implementing Balance Scorecard drove other management activities of the organization as well. For example, the construction and promotion of Activity-Based Costing, the form of management dashboard, the modification of medical service flow path, and the spread of Lean. Many management activities are under Balance Scorecard System, and gradually pieced up a hospital integrated performance management platform. The fifth discovery: the second of the case hospital to promote the balanced scorecard is a strategic themes as the spindle, so not only can the limited resources the most effective investment, more policy focus; specific implementation strategy, the hospital-level key performance indicators to all levels of units, starting from the six strategic themes for the hospital-level KPI set to undertake sector, must undertake the department of the strategy map, key performance indicators and program of action with linking the Hospital vision and strategic objectives. Relevant departments in addition to a strategy map and program of action necessary to undertake hospital-level policy goals, and can develop their own key performance indicators in accordance with the Department of feature when it’s not against the direction of the hospital overall operating strategy. Those departments and the hospital overall strategic goal is not only more in consistent, but also in accordance with the Branch development characteristics of elastic operation with forward toward the hospital vision. The case hospitals to promote the balanced scorecard from the assessment of management tools, budget, financing, promotion and operation of the system, accounting personnel actively play a chief of staff role. Researchers thought that the organization is to promote change or import new management tools, support and participation of the accounting department is extremely important, especially accounting managers should serve as a model, leading the team actively involved in it. Researchers as the Hospital Accounting Officer, occupies a project director for the topic of “Management Achievement optimization”, in the balanced scorecard work activities and participation in the operation of the decision-making level Strategy Committee. Will put forward specific recommendations are to obtain a high degree of recognition and adoption of the leadership, such as motor joining or withdrawing from stabilization program, the establishment of the strategic budget system, the ABC activity-based cost management system to promote. In recent years, view of the excellent operating performance of the case hospital, the Balanced Scorecard has indeed played an intended function. Hospitals in the implementation of the Balanced Scorecard process, the accounting department has indeed played an active and important role. Made a specific contribution to the promotion of the overall system, but also enhance the function and value of the accounting department in the organization. |
