|摘要: ||本篇研究主要是以某醫學中心的外科加護中心為對象，利用平衡計分卡（Balanced scorecard，BSC）中的四大構面，進行該部門單位護理工作表現之績效衡量。第一階段以醫院的願景為主軸配合單位願景、SWOT分析，策略地圖確立策略性議題與目標，再由主管會議訂定出各構面之權重。第二階段依據策略性議題與目標進行資料收集、文獻查證與焦點訪談找出19項績效指標，再由19項績效指標確立適合該單位之11項績效衡量指標，其中包含財務構面的有2項，分別為（1）加護病床佔床率、（2）加護中心初級儀器保養率；顧客構面的有3項，分別為（1）病患家屬總體滿意度、（2）病人或家屬抱怨件數、（3）加護中心護理人員整體滿意度；內部流程構面的有3項，分別為（1）壓瘡新發生率、（2）非計劃性氣管內管滑脫率、（3）泌尿道感染；學習成長構面的有3項，分別為（1）每位員工每季在職教育時數、（2）護理人員ACLS(Advanced Cardiac Life Support)具有效證書率、（3）個案報告每半年之通過率。 第三階段依據這些績效指標，進行行動方案的執行，再做實證研究比較實施前及追蹤實施後的第3、6個月加護中心護理績效表現之差異。
經行動方案後進行平衡計分卡實施後:（一）財務構面：1.加護病床佔床率由實施前92％上升至實施後第6個月為95％；2.加護中心初級儀器保養率由實施前52.1％上升至實施後第6個月為98.7％；（二）顧客構面：1.病人家屬總體滿意度由實施前4.27分明顯提升至實施後第6個月為4.62分；2.病人或家屬抱怨件數由實施前6件下降至實施後的 2件；3.加護中心護理人員整體滿意度由實施前3.2分，上升至實施後第6個月為3.8分；（三）內部流程構面：1壓瘡新發生率由實施前0.39％下降至實施後第6個月為0.00％；2.非計劃性氣管內管滑脫率由實施前0.53％，實施後第6個月有稍略上升至0.54％，但仍在預設值內；3. 泌尿道感染由實施前16.7‰，下降至實施後第6個月為9.2‰；（四）學習成長構面：1.每位員工每季在職教育時數，由實施前43.4％，上升至實施後第6個月為81.1％；2.護理人員ACLS(Advanced Cardiac Life Support)具有效證書率由實施前87.8％，上升至實施後第6個月為95％；3. 個案報告通過每半年之通過率由實施前92％，上升至實施後的100％。平衡計分卡實施前之策略目標總達成率為86.02﹪、實施後的第3個月總達成率為92.59﹪、實施後第6個月之總達成率高達93.50﹪。
The goal of this study is to evaluate the effectiveness of the Balanced Scorecard Card in assessing the nursing performance in a surgical intensive care unit of a tertiary medical center. The Balanced Scorecard Card enables an organization to convert its mission into specific objectives across four perspectives: (1) the financial perspective, (2) the customer perspective, (3) the internal business process perspective, and (4) the learning and growth perspective. This study consisted of 3 stages, the task of the first stage was establishing the vision of surgical intensive care unit (ICU) which linked with the mission of our hospital, the SWOT analysis establish the goal of each subject from the strategy map, and, afterwards, the final selection was decided depend upon the weight of the each goal from repeated conferences by the directors of all departments. The task of the second stage was looking for the efficacy targets from data collection, literature reviewing, and discussing with key-persons based on the strategy objectives In the second stage, 19 efficacy targets were selected, but only 11of the 19 targets were established due to the concerning of the specific weighting and suitability of the surgical ICU.These efficacy targets included: two items of the financial perspectives: (1) the rate of occupied bed in surgical ICU. the rate of primary instrument maintenance; three items of the customer perspectives : (1) overall satisfaction rate from the families, (2) frequencies of complaints from the patients or the family members, (3) overall satisfaction rate from the nursing staffs ; three items from the internal business process perspective: (1) rate of the new developed pressure sores, (2) rate of unplanned extubation, (3) rate of urinary tract infection; three items of the learning and growth perspective: (1) greater than 25-hrs of on-job training of all nurses in each season , (2) the rate of getting Advanced Cardiac Life Support (ACLS) certificate, (3) the passing rate of a case reports every 6-months. The task of the third stage was carrying on active measures based on the efficacy targets and compared the nursing performance before and after implementation of the Balanced Scorecardcard at the 3- and 6- month.
Results revealed that after implementation of the Balanced Scorecard Card, there were a lot of beneficial changes:
1. in the financial perspective: （1）the rate of occupied bed in surgical ICU changed from 92% to 95% after implementation of the Balanced Scorecard Card.（2）the rate of primary instrument maintenance changed from 52.1% at the begining to 98.7% at the 6-months.
2. in the customer perspectives:（1）overall satisfaction rate from the families changed from 4.27 before to 4.62 at 6-months after implementation of the Balanced Scorecard Card.（2）the frequencies of complaints from the patients or the family members dropped from 6 episodes to 2 episodes after implementation.(3) overall satisfaction rate from the nursing staffs rose from 3.2 at the beginning to 3.8 at the 6-months after implementation.
3. in the internal business process perspective:（1）the rate of the new developed pressure sores dropped from 0.39% at the beginning to 0.00% at the 6th-months after implementation of the Balanced Scorecard Card.（2）the rate of unplanned extubation changed insignificantly from 0.53% to 0.54%.（3）the rate of urinary tract infection dropped from 16.7 ‰ at the beginning to 9.2‰ at the 6th-months after implementation.
4. in the learning and growth perspective:
（1）greater than 25-hrs of on-job training of all nurses in each season increased from 43.4% to 81.1% at the 6th-months after implementation.（2）the rate of getting ACLS certificate increased from 87.8% to 95%.（3）the passing rate of a case reports every 6-months increased from 92% at the beginning to 100% at the 6th-months after implementation of the Balanced Scorecard Card. As for the accomplishment rate for strategy goal, it increased from 86.02 ﹪at the beginning to 92.59﹪at the 3 months and to 93.50﹪at the 6months after implementation of the Balanced Scorecard Card.
In conclusion, this study demonstrates that the implementation of Balanced Scorecard Card is beneficial for improving the quality of nursing performance in surgical ICU in a tertiary medicine center.