公立醫院照服員業務委外之研究：以新竹某醫院為例

Research on the Outsourcing of Caregiver Services in Public Hospitals: Taking A Hospital in Hsinchu as An Example

10.6712/JCPA.202406_(34).0005

洪英珊(Ying- Hsan Hung)；石振國(Chen-Kuo Shih)

委外 ； 醫院業務委外 ； 照服員 ； Outsourcing ； Hospital Business Outsourcing ； Caregiver

中華行政學報

34期（2024 / 06 / 30）

77 - 96

繁體中文;英文

因醫學科技發達及經濟發展，臺灣2025年人口平均壽命65歲以上的高齡者將占總人口20%，將邁入超高齡社會，而家庭結構也因少子化、雙薪家庭等因素，家人住院時能提供之陪病照顧相對減少，僱用照服員已成普遍現象；本研究就醫院照服員業務委外進行探討，並以質性研究之半結構方式訪談新竹縣某公立醫院相關人員，以瞭解醫院非核心之照服員業務委外案運作現況、院方執行時所面臨之困境、履約監督之過程及委外之成效與影響。本研究之主要研究發現如下：在委外目標與權責分工方面，業務委外係配合政府推動業務委外政策趨勢，以控制成本支出、減少人事管理成本、藉由專業分工等來提升醫療品質為主要目標，性質上屬於非核心業務委外，由總務室及護理部共同負責，前者屬契約管理單位，後者屬人員使用單位。在履約監督與管理方面，本案以最有利標辦理評選承包商，以確保後續履約品質；過程中除基於契約進行監督與查核外，並透過溝通與互信關係的建立，在不違反法令規範下授權廠商可彈性應對，以達更好的照護品質。在履約績效與影響方面，權責單位透過承包商之工作報告、滿意度調查、成本效益及營運狀況等來評估委外績效，並發現各方均認為本案能達成委外目標，但受制於照服員市場供不應求影響，專業度與服務品質仍有提升的空間，主管機關與醫院方面也持續透過訓練方式進行改善。

As a result of advancements in medical technology and economic progress, it is projected that by 2025, Taiwan will experience a demographic shift where individuals aged 65 and older will make up 20% of the total population, leading to the classification of a super-aged society. Changes in family dynamics, influenced by factors such as decreasing birth rates and an increase in dual-income households, have reduced the capacity of family members to provide care for hospitalized individuals. Consequently, the practice of hiring caregivers has become widespread. This research delves into the practice of outsourcing caregiver services in hospital settings, utilizing qualitative semi-structured interviews with pertinent staff members from a public hospital in Hsinchu County. The aim is to gain insights into the current processes involved in outsourcing non-core caregiver services in hospitals, the obstacles encountered by the hospital during implementation, the methods employed for monitoring performance, as well as the efficacy and repercussions of outsourcing in this context. The primary research outcomes of this study indicate that business outsourcing aligns with government initiatives promoting outsourcing policies, focusing on goals such as cost control, reduction of personnel management expenses, and enhancement of medical quality through specialized division of labor. The outsourcing pertains to non-core business functions, overseen jointly by the general affairs office and the nursing department, with the former managing contracts and the latter handling personnel deployment. Performance oversight involves selecting contractors through competitive bidding to ensure quality, along with contract-based monitoring and auditing, fostering communication and trust to enable vendors to adapt within legal frameworks for improved care quality. Evaluation of outsourcing performance by the relevant units is based on contractors' reports, satisfaction surveys, cost-effectiveness, and operational status, demonstrating achievement of outsourcing objectives in this instance. Nevertheless, due to caregiver shortages in the market, there remains scope for enhancing professionalism and service quality, prompting ongoing efforts by both regulatory bodies and the hospital to enhance training methodologies.