根據台灣醫療改革基金會（Taiwan Healthcare Reform Foundation, THRF）資料的顯示，台灣的護病比例為1:13，而國際護病比標準為1：6，台灣存在明顯的醫療資源不足問題。提高現有醫療資源的有效利用率，是解決該問題的有效方法之一。而精實管理（Lean Management）能夠使醫療產業有限資源的應用最大化。
由於強度調控放射治療設備價格昂貴，對該設備的有效利用也引起了醫療機構的重視。因此，本研究將精實管理技術應用於強度調控放射治療 (Intensity-Modulated Radiation Therapy, IMRT)治療流程研究。本研究將通過提出流程改善研究架構與改善方案，縮短治療時間，增加單日可治療人數，從而提高該設備的有效利用率。
本研究將於於馬偕紀念醫院淡水分院進行實證分析。研究主要分為三個階段。第一階段將採用快速換模（Quick Changeover, QCO）技術與其它精實管理方法調查分析與研究馬偕紀念醫院強度調控放射治療流程，尋找存在的浪費與改善機會，從而提出改善方案。第二階段將應用Flexsim系統模擬軟體對選擇出來的改善方案進行模擬研究，以分析其改善效益。第三階段將採用多屬性決策分析理論（Multi-Attribute Decision Analysis, MADA），針對馬偕醫院的目標與各方案的改善效益，解決改善方案之選擇決策問題。
本研究將考量現實醫療流程之特性，將自馬偕紀念醫院蒐集到之真實資料通過精實管理理論與決策分析理論之分析與研究，提高馬偕紀念醫院之管理效率與競爭力。

According to Taiwan Healthcare Reform Foundation (THRF), Nurse-Patient Ratios is 1:13 in Taiwan, while the international standard is 1:6, which reveals a tension in medical resources in Taiwan. Improving the usage rate of medical resources is one of efficient methodologies, which means Lean Management can be adopted. Due to high price of Intensity-Modulated Radiation Therapy (IMRT) equipment, the effective utilization of IMRT equipment has been paid more attention. Therefore, lean management techniques are applied in improving IMRT treatment process in this study.
This study proposed a process improvement framework for reducing the total time of IMRT treatment process, increasing the capacity of treatment per day and finally improving the usage rate of IMRT equipment. It was used to improve IMRT process of MacKay Memorial Hospital (MMH) Tamsui Branch for empirical study. Three phases are included in the research. Firstly, the IMRT process at MMH will be investigated to identify the waste and improvement opportunities. Quick Changeover (QCO) technique and other lean tools were used. Secondly, software FlexSim was used to analyze the efficiency of improved solutions. Finally, the problems of decision making for the selection of improved solutions were identified and solved. Multi-Attribute Decision Analysis (MADA) theories was applied.
This research took into account the practical characteristics in healthcare processes. The approach was specific to the case study, but the same methodology can be applied in other healthcare environments.

摘要 I
Abstract II
致謝 III
Contents IV
List of Tables VII
List of Figures X
Chapter 1: Introduction 1
1.1 Background and Motivation 1
1.2 Research Objectives 2
1.3 Research Method 3
1.4 Organization of Thesis 4
Chapter 2: Literature Review 5
2.1 Lean Management in Healthcare 5
2.2 Quick Changeover (QCO) 7
2.3 Multi-Attribute Decision Analysis (MADA) 11
2.4 Simulation Analysis 12
Chapter 3: Methodology 16
3.1 Research Framework 16
3.2 Process Improvement Analysis 19
3.2.1 QCO Technique 20
3.2.2 Observe / Measure the Current Process 21
3.2.3 Analyze Current Process 23
3.2.4 Develop Improved Process Solutions 28
3.2.5 Streamline Improved Process 30
3.3 Efficiency Analysis 31
3.3.1 Collect and Analyze Data 31
3.3.2 Build Simulation Models 32
3.3.3 Analyze Simulation Results 33
3.4 Decision-Making Analysis of Improved Alternative 34
3.4.1 Choose a MADA Method 34
3.4.2 Define Decision Objective 35
3.4.3 Build Sub-Objective & Evaluation Attribute Framework 36
3.4.4 Compare Improved Alternative Solutions 37
3.4.5 Overall Judgement 38
Chapter 4: Empirical Study 39
4.1 Background 39
4.2 Process Improvement Analysis 43
4.2.1 Research Framework 43
4.2.2 Observe / Measure the Current Process 43
4.2.3 Analyze Current Process 47
4.2.4 Develop Improved Process Solutions 59
4.2.5 Streamline Improved Process 68
4.3 Efficiency Analysis 74
4.3.1 Collect and Analyze Data 74
4.3.2 Build Simulation Models 79
4.3.3 Simulation Results Analysis 83
4.4 Improved Alternative Decision-Making 100
4.4.1 Choose a MADA method 100
4.4.2 Define Decision Objective 100
4.4.3 Build Sub-Objective & Evaluation Attribute Framework 101
4.4.4 Compare Improved Alternative Solutions 104
4.4.5 Overall Judgement 107
Chapter 5: Conclusion and Future Work 108
Reference 111
Appendix 119
Appendix A: Data Testing Figures of Patient’s Activities 119
Appendix B: Data Testing Figures of Therapists’ Activities 123
Appendix C: Questionnaire of Objectives and Attributes Evaluation
129
Appendix D: Questionnaire of Solution Election 135

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