一個運作良好的醫療系統不僅可以挽救病人的生命，而且為醫療人員提供良好的工作環境。儘管20世紀以來精實管理已經引入到醫療保健系統中，但以前的大部分研究都是實施5S和一些簡單的技術。只有少數研究解決了醫療系統的隨機性及最佳化問題。因此，本研究旨在醫療系統中執行精實管理中的精實技術和一個隨機規劃模型來同時達到效率和負載平衡。健康檢查中心的案例證明了所提方法的好處。結果表明，實施精實管理及隨機規劃模型後，效率改善約15％。在這篇研究中，我們運用精實管理手法去改善流程的服務時間，為更多的客戶提供服務，再藉由隨機規劃模型去最大化效率使流程中各工作站的負載平衡。總而言之，結合精實管理和隨機規劃模型，可以成功地平衡健檢中心的流程。這種方法可以作為一個決策支持系統來協助其他服務系統的精實改善。

A well operated healthcare system not only can save lives but also provide good work environment for medical staffs. Although lean management has been introduced to healthcare system since 20 century, most of previous studies solely implemented with guidelines such as 5S and some simple techniques. Only a few researches address the stochastic nature of healthcare system. Therefore, this study aims to implement lean management in the healthcare system with lean techniques and a stochastic programming model to achieve both efficiency and loading balance simultaneously. An empirical case of physical examination center demonstrates the benefit of the proposed method. Primary results show that after implementing lean management and stochastic programming model, efficiency is improved about 15%. With the integration of lean management and stochastic programming model, this study successfully balance the process flow of physical examination center. This method can serve as a decision support system to assist other service systems in lean improvement.

摘要 II
目錄 III
圖目錄 IV
表目錄 IV
1 緒論 5
2 文獻探討 7
2.1 精實管理應用在醫療保健 7
2.2 數學規劃模型應用在醫療保健 10
2.2.1 確定性數學規劃模型 11
2.2.2 隨機性數學規劃模型 12
2.2.3 總結 13
2.3 蟻群演算法 14
2.4 總結 16
3 研究方法 17
3.1 精實方法 17
3.1.1 操作流程圖 17
3.1.2 魚骨圖 18
3.1.3 過程分析 18
3.1.4 看板管理 18
3.1.5 交叉培訓 19
3.1.6 生產線平衡 19
3.2 隨機規劃模型 19
3.2.1 定義問題及假設 19
3.2.2 定義變數及符號 20
3.2.3 隨機規劃模型 21
3.2.4 簡單例子 23
3.3 演算法 24
4 個案研究 26
4.1 個案 – 健康檢查中心 26
4.2 敏感度分析 41
4.3 討論 42
5 結論 45
6 參考文獻 46
7 附錄 53

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