پروژه شاخص کیفیت تایوان و رشد بهره وری بیمارستان

The Taiwan Quality Indicator Project (TQIP) is a quality management program that measures and monitors the healthcare quality of hospitals in Taiwan. This paper examines the impact of TQIP participation on hospital productivity growth with the application of the Malmquist productivity change index based on data envelopment analysis (DEA). Analyzing operations data from 31 TQIP regional hospitals over the period 1998–2004, we find that TQIP hospitals improved their productivity in the post-TQIP period. This improvement is attributable to quality change and relative efficiency progress. The simultaneous enhancement in both quality and relative efficiency coincides with the philosophy of total quality management (TQM) spirit, and confirms the efficiency improvement and quality assurance functions of TQIP.

The growing trends of rising healthcare costs and increasingly aging population have forced the government and healthcare providers to be more concerned with healthcare resources productivity [1] and [2] and quality [3], [4], [5], [6], [7] and [8]. However, an inefficient utilization of healthcare resources has been one of the major reasons for inflated spending on healthcare services [9]. This inefficient use of resources, in conjunction with a greater consciousness of the importance of healthcare system reform has led to more scrutiny of the cost effectiveness of healthcare delivery services [4] and [10]. To promote cost-effectiveness, nearly 70% of US hospitals have implemented total quality management (TQM) and continual quality improvement (CQI) programs [11]. Bosworth et al. [12] validated that progress in quality improvement contributed to the productivity growth. In 1999, the Department of Health of Taiwan established the Taiwan Joint Commission on Hospital Accreditation (TJCHA) whose ultimate goal is to integrate and upgrade the healthcare quality system. Based on the successful experience and international benchmarking of the Maryland Quality Indicator Project (MQIP) and International Quality Indicator Project (IQIP), TJCHA initiated the Taiwan Quality Indicator Project (TQIP) in 2000 to pursue its mission of excellence in healthcare quality. In particular, TJCHA adapted the following three types of quality indicators for TQIP: acute care indicators, psychiatric care indicators, and long-term care indicators [13]. The Department of Health of Taiwan also encouraged hospitals to collect and utilize the acute care indicators to facilitate improvements in healthcare quality and productivity. In this study, we evaluate the productivity changes of Taiwanese hospitals after joining the TQIP in 2000 using the Malmquist [14] productivity change index based on non-parametric data envelopment analysis (DEA). Prior studies have shown the flexibility of DEA over traditional parametric methods in estimating hospital productivity [15] and [16]. The Malmquist productivity change index can be used to track the specific position corresponding to each hospital and to examine changes in productivity and quality [17]. Färe et al. [18] advanced the Malmquist productivity index to measure changes in the following three components of productivity growth: quality change, efficiency change, and technical change. The use of the Malmquist productivity change index enables us to identify individual components of changes in hospital productivity, especially changes in efficiency and quality [17]. Prior studies on healthcare productivity have focused on organizational determinants, technology involvement and policy intervention [7], [9], [19] and [20]. They estimated the input–output correspondence and typically ignored the potential impact of healthcare quality indicators such as outcomes on productivity measurement due to lack of quality indicators. We attempt to overcome this problem by incorporating the quality indicator in our estimation. Specifically, we examine productivity change and its three components (quality change, relative efficiency change, and technical change) from the pre-TQIP period to the post-TQIP period. Analyzing operations data from 31 TQIP regional hospitals in Taiwan from the pre-TQIP period (1998) to the post-TQIP period (2002 and 2004), we find that TQIP hospitals demonstrated significant productivity growth in the post-TQIP period. This growth is attributable to quality change and relative efficiency progress, meeting the TJCHA's expected goal. Our results also indicate that efficiency and quality improve simultaneously after TQIP participation, which coincides with the philosophy of total quality management (TQM) and confirms the efficiency improvement and quality assurance functions of TQIP. The remainder of this paper is presented as follows. Section 2 provides background, including the definition of healthcare quality, description of the Taiwan Quality Indicator Project (TQIP), and a brief review of related literature on healthcare quality and hospital productivity to motivate research hypotheses. Section 3 presents the research design including description of sample data and construction of the Malmquist productivity change index using DEA models. Section 4 presents and discusses the empirical results and Section 5 concludes the paper.

The goal of TQIP is to promote overall healthcare quality. In this study, we empirically evaluate the impact of TQIP adoption on hospital productivity and healthcare quality. Using the empirical data on 31 TQIP regional hospitals in Taiwan over the periods 1998–2004, we examine the impact of TQIP on productivity change, quality change, and relative efficiency change. In particular, we analyze the changes in efficiency and quality derived from the Malmquist productivity change index. Our results indicate that hospitals had improved their healthcare quality, efficiency, and total productivity from the pre-TQIP period (1998) to the post-TQIP implementation period (2002 and 2004). Efficiency and quality improve concurrently after TQIP participation, which coincides with the philosophy of TQM. That is, hospitals are able to improve their operating efficiency without sacrificing their healthcare quality. Our study results have the following policy and managerial implications. First, the mission of healthcare is to promote the healthcare quality. Our study assures that quality indicator systems facilitate the continuous improvement of healthcare quality. Second, our findings suggest that healthcare quality and efficiency can be achieved simultaneously. The advancement in healthcare quality would lead to improvements in healthcare productivity and quality improvement as well. Third, the healthcare quality progress requires transformation of time and input resources.