由豐田生產制度發展而來的精實管理，近年來逐漸運用於醫療照護產業。在競爭激烈的環境下，使用精實醫療思維，系統化看待整個流程以消除浪費、改善品質，不再只是著重專業技術的進步，而是價值的重新檢視。

本研究針對職能治療復健動線和流程，運用現況觀察進行分析，改善不必要浪費情形，在有限的資源下，找出解決和調整方法。改善作業流程時間，優化治療動線，來降低工作行走步數和心智負荷量，讓職能治療師工作發揮最大效率，並提升工作滿意度。藉由改善後的流程，縮短病患等待時間，增加器材使用效率。透過標準化作業流程修正，提高醫療服務品質和病患就醫滿意度。

利用現場觀察和價值流分析問題，探討浪費情形，導入精實手法，如標準化作業流程、5S活動、目視化管理、看板…等改善活動。消除治療環境重覆多餘混亂、被忽略的作業程序；利用病患觀點檢核週期效率和器材使用效率。門診病患流程週期效率改善前66.34%，改善後提升至73.60%，效率增加7.26%。住院病患流程週期效率改善前84.57%，改善後提升至86.35%，效率增加1.78%。改善後器材總使用次數為112次較改善前94次的使用效率增加。從治療師觀點探討，工作行走步數、心智負荷量、5S檢查表之分數變化。改善前步數平均值為2,848步，改善後步數平均值為2,311步，減少537步；改善前心智負荷量平均值為75分、改善後心智負荷量平均值為56分，降低19分，兩者皆達統計顯著差異。5S檢查表從改善前57分提高到80分，呈現進步情形。

精實醫療觀點檢視職能治療環境、病患動線，消除不必要的浪費情形，提升了組內5S評核分數、門診和住院病患流程週期效率、儀器使用率，降低治療師心智負荷量、行走步數。未來研究方向可於治療師、病患及醫院三方面進行後續探討，在治療師方面：可延伸運用心智負荷量的評估範疇和業務執行的關聯性。在病患方面：精實醫療在顧客價值的展現或融合資訊化，提升全方位的醫療服務。在醫院方面：精實服務如何消除浪費、防範未然、創造獲利；重新定義彼此間的角色，聚焦核心資源。

Lean management developed from the Toyota Production System has gradually been applied to healthcare in recent years. Under a competitive environment, the whole process with thinking of lean healthcare would help to eliminate waste, improve quality, and focus on renewing the value rather than improving professional technique.

This study aimed to improve layout and processes in Occupational therapy. The situation of waste was evaluated by clinical observation, value stream mapping analysis, and lean management. When utilized lean management, standardized procedures, 5S activities, visual management, and Kanban were selected to include in the improvement program in the current study. Furthermore, we eliminated unnecessary or ignored process during treatment as well as the efficiency of the process cycle and equipment were evaluated from patients’ perspective. The efficiency of outpatients' process cycle increased from 66.34% to 73.60% and inpatients' process cycle increased from 84.57% to 86.35% while the times of equipment increased from 94 to 112. In addition, the number of walking steps, mental workload, and scores of the 5S checklist were also analyzed from therapists’ perspective. The average walking steps during treatment significantly reduced from 2,848 to 2,311 and the average of the scale of mental workload dropped from 75 to 56. Furthermore, the score of 5S checklist increased from 57 to 80, which represented an improvement on the neat and tidy of the environment.

The current study improved the dynamic process with low job satisfaction in the workplace to benefit the overall operation process time, optimize the treatment dynamics, and maximize the efficiency of occupational therapists. Meanwhile, standardization of workflow and clear guidelines would help to maintain the system. It increases the consistent implementation of medical services and improve job satisfaction.

摘要 I
Abstract II
誌謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究目的 3
1.4 論文結構 4
第二章 文獻回顧 5
2.1 精實管理於醫療上的應用 5
2.2 醫療服務現況 9
2.2.1 醫療現況的浪費種類 10
2.2.2 以復健科為例的浪費情形 12
2.3 改善手法 16
2.3.1 現況觀察與價值流 18
2.3.2 5S 20
2.3.3 目視管理 24
2.3.4 標準化作業 25
2.4 改善的效果 27
2.5 工作心智負荷評量 28
第三章 研究方法 32
3.1 病患使用治療儀器動線方式 33
3.2 治療師 41
3.2.1 研究工具 41
3.2.2 方法介紹 42
3.3 統計分析 44
3.3.1 病患 45
3.3.2 治療師 45
第四章 研究結果與討論 46
4.1 病患 46
4.1.1 觀察結果與討論 46
4.2 治療師 53
4.2.1 改善前後的比較結果 53
4.2.2 改善手法討論 61
4.2.3 研究限制 76
第五章 結論與建議 77
5.1 結論 77
5.2 建議 78
5.3 未來研究方向 78
參考文獻 80
附錄一：心智負荷主觀評估量表（NASA-TLX） 85
附錄二：職能治療組 5S檢查表 87

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