指標→閾值(SPC) - chimei.org.tw

1 (SPC) Indicators / index / norm / quota / target ? (Quantitative measure) (Quantitative measure) (Nadzamet. al. 1993) JCAHO JCAHO (screen) (flags) (Decker & Sprouse 1992) JCAHO JCAHO ( ) JCAHO ( ) ( ) (Assign Responsibility) ( ) (Delineate Scope of Care) ( ) (Identification of Important Aspect of Care) ( ) (Identify Indicators) ( )( ) ( ) (Establish A Means to Tagger Evaluation) (Thresholds) ( + )( ) (Collect and Organized Data) g( ) (Initiate Evaluation) ( )( ) (Take Action to Solve Problems) ( )( ) (Take Action to Solve Problems) ( )( ) (Access effectiveness of Actions and assure improvement is maintained) + ( ) (Communication)TRM( )

2 Joint Commission on Accreditation of Healthcare Organization Joint Commission JCAHO 1991 1988 JCAHO(1991 1988) JCAHO ( ) (Assign Responsibility) ( ) (Delineate Scope of Care) ( ) (Identification of Important Aspect of Care) ( ) (Identification of Important Aspect of Care) (high-volume) (high-risk) (ProblemProne) ( ) (Identify Indicators) ()(y) (Quantitative Measure)( ) (Establish A Means to Tigger Evaluation) (Thresholds) ( ) (Collect and Organized Data) ( ) (Initiate Evaluation) ( ) (Take Action to Solve Problems) ( ) (Access effectiveness of Actions and assure improvement is maintained) ( ) (Communication) JCAHO ( ) (Communication) JCAHO ( ) - A: : 114C C: C: 5 B: C 117B: B: : : B A.

3 A .. ? ? (threshold) ? ? ? Managing Quality: A Guide to Monitoring and Evaluating NursingMonitoring and Evaluating Nursing ServicesHardcover, 250 pages, release 1992-01 Authors: Eleanor Green Jacqueline KatzAuthors: Eleanor Green, Jacqueline KatzManufacturer: Mosby-Year BookISBN: 080162620X (1) (2) (3) 30 ( ) +1 +2 +3 (4) (5) - 99 (85 08%) 100 356 99 ( )100 85% 7-12 100 12 90 99 100 100 100 * 10001 10002 10003 10004 10005 10006 10007 10008 10009 10010 10011 10012 -SPC UCL = =0 863P = (sigma)= * = +1 +2 +3 - 1n>1 n=1 n1 ( 0 1 ) IXbarS n n n )Th t U ChartIchartXbar-SXbar-Rn P chartn C chartn U chartT chart I-MRU Chart Skyline IMR SPC SPC SPC SPC a.

4 (Shewhart) 1924 b. 1940 SPC SPC 1950~1980 c. 1950 ( Deming) SPC 30 30 SPC SPC (Control Chart) (Control Chart) (Centerline, CL) (Upper Control Limit UCL) (Lower Control Limit LCL) Control Limit,UCL) (Lower Control Limit,LCL) normal distribution Gauss Karl F. Gauss 1777-1855 Gaussian distribution 3 6 6 100(1- ) 100(1 ) 3 3, UCL = LCL = () (CL)= (UCL)= + 3 (LCL)= -3 ( ) P CHART nP CHART C CHART u CHART 1 -1 IQIP IQIP 2 -2 2-3 2-3 (1) (2) (3) (4) TQIP THIS SPC systematic reduction of variability yy - 1n>1 n=1 n1 ( 0 1 ) IXbarS n n n )

5 Th t U ChartIchartXbar-SXbar-Rn P chartn C chartn U chartT chart I-MRU Chart Skyline IMR SPC 1. 1-1 n=1 or n>1 ->Xbar-R chart2 2. 2-1 (n )->P chart22 ( )Ch2-2 (n )->C chart2-3 (n )->U chart()2-4 ( 0 1 )->T chart25 >U Chart Skyline 2-5 ->U Chart Skyline Ichart -I chart1. 1-1 = / ( OHCA) .. XRIdiid l Ch XmR Individuals Chart Pchart -P chart2. 2-1 ->(n )->P chart ( )= / ( OHCA) cp / = cvp / Cchart -C chart2. 2-2 ->(n )->C chart = / / / Uchart -U chart2. 2-3 ->(n )->U chartchart / = / = / = / Tchart -T chart2.

6 2-4 / / , and Hart, , Statistical Process Control for Health Care, Thomson ( )2. , , Introduction to Statistical Quality Control, John Wiley &Statistical Quality Control, John Wiley & Sons. 4 4. 5. -SPC !!!