本研究致力於作業流程之分析研究與存貨管理決策的探討，希望藉由個案單位為例出發，經由進貨、銷貨（供餐）、存貨的流程分析與再造，提出一套適合個案醫院特殊營養品存貨的最佳管理機制，目前管理者尚延用過去的經驗法則，使得特殊營養品項目訂購及儲存成本無法有效地改善與降低。本研究乃針對某醫學中心營養室管灌食作業流程及盤餐配膳作業流程進行流程改造。該醫學中心每年多達約541,000人次以上使用管灌飲食及盤餐飲食，而營養室每天供應管灌飲食的人次均超過七百人次，如此頻繁且密集的作業需求增加營養室作業管理上的困難。本研究透過流程分析發現管灌飲食六項問題點：[1]因原有表單不適用於現行流程，造成作業效率不彰；[2]因作業方式不當易產生錯誤；[3]因缺少報廢流程造成管理者無法掌握報廢成本與原因；[4] 因工作流程缺乏資訊化，造成人工作業成本增加及錯誤率較高；[5]因物料流與資訊流脫節，造成無法掌握物品實際耗用量；[6]因統計表單設計不當，無法提供管理者所需資訊。為解決上述管灌飲食作業之問題，本研究提出由連續八個步驟所構成的改善方案：[1]建立灌食間人員作業表單取代個別製作單；[2] 重新設計飲食變更通知單及作業方式；[3]將標籤導入現有作業取代餐條黏貼；[4]建立送餐表單取代餐條送餐；[5]增加管灌飲食報廢申請流程；[6]重新設計第二醫療大樓罐裝灌食領貨流程；[7]增加灌食間及第二醫療大樓小庫房的盤點流程；[8]建立營養室資訊系統。在存貨管理方面，若能依照決策情境推演數學模式，訂定最佳訂購策略，以使每單位時間總存貨成本減到最小，提供決策者解決存貨增加所造成資金成本增加及減少缺貨發生之問題，保持服務水準，經實驗結果證實確可有效改善決策品質、降低訂購及儲存成本，提升個案醫院競爭力及營運績效。 This study focus on the re-engineering of Tube-Feeding-Diet (TFD) operation processes and inventory management in the Nutrition Department in a Medical Center. After conducting careful analysis, we found many problems including inappropriate design of the existing tables and sheets, improper operations in the processes, no discarding procedure was designated and no statistical sheets are available for the managers, etc. In order to solve the above problems, we propose a series of eight-step action items: (1) Design new tables and sheets to replace the inappropriate ones in the TFD service operation processes. (2) Modify the design of the diet-change order sheet and change the operation processes. (3) Replace the existing diet-sheet with a new self-sticking label accompanying with a new design that shows clear and necessary information. (4) Introduce new catering tables and sheets to replace the existing ones. (5) A discarding procedure is proposed for the TFD service operation processes. (6)Re-design the replenishment operation procedure for canned TFD items in Building No.2. (7) Set up an inventory auditing procedures for the TFD items in the preparation room in Building No.1 and the storage room in Building No.2. (8) Establish a new web-based information system to assist the Nutrition Department in the TFD service operation processes. Following cautious assessment, the Nutrition Department not only is able to solve the problems using the six proposed action items, but also secure a cost-saving of $NTD 40,000 each month.To control the inventory of the TFD items, the managers are desperate for a systematic infrastructure and more efficient approaches for optimal purchasing policy derivation. For each category of the TFD items, we employ a mathematical model for obtaining an optimal purchasing policy so as to minimize the total inventory costs per unit time. This study proposes the managers in TCVGH a useful decision support system to significantly improve the efficiency of the operations of the TFD items by reducing the inventory costs and improving the replenishment processes from the suppliers.
