面對因全民健康保險制?的調整所帶?成本及?潤的改變，醫?院所的經營及管?者?有著相當程?的營運壓?。各醫療院所為維持既有的營運利潤，開始採行「開源節流」的策略以降低營運成本。由於國內醫學中心、大型醫院的衛材種類繁多，衛材存貨成本高、庫房及醫療單位衛材存貨的囤積、過時的衛材成為呆滯品等衛材管理的困難造成了醫院營運成本的提高。除此，衛材管理缺貨問題，也常讓管理人員四處向其他科室或是醫療單位調貨，使得原本就忙碌的醫療作業更加混亂。如何使醫療院所的存貨水準在過高與不足間取得平衡為衛材管理人員的挑戰。從過去的文獻中發現，許多學者提出存補貨政策以解決存貨問題，並透過數學、演算法或模擬等方法求解政策中的參數值，但是這些方法多是藉由?學模式或演算法?解決，在找尋參數的過程中過於複雜，同時當需求趨勢改變時必須重新進行複雜的計算，在實際應用上相當困難。針對上述問題，限制??(Theory of Constraints, TOC)提出以用多少才補多少的Demand-Pull管?模式及緩衝管理以克服這些缺點。本研究將結合此兩種概念的鼓－緩衝－繩 (Drum-Buffer-Rope;DBR)模式應用於醫院的衛材管理，提出動態的鼓－緩衝－繩之衛材管理模式(Dynamic Drum-Buffer-Rope; DDBR)，並藉由系統動力學協助設計DDBR模式。本研究並以中部某教學醫院之牙科部為例，透過模擬驗證DDBR模式可幫助個案牙科部?低整體的庫存水準以及避免缺貨情形之發生。驗證結果顯示DDBR衛材補貨模式相較於個案牙科部現行的作業模式，可有效避免缺貨之情形發生，且可控制其衛材的存貨水準於一穩定的狀態，避免存貨過高或是不足之現象發生。 Since the implementation of Health Insurance system, medical institutions have been faced with huge cost pressures. However, the management of a wide range of medical materials is troublesome since the high inventory costs, the hoard in medical materials, and the outdated materials that cause high operation costs.From a literature review, we found that many researchers have proposed various kinds of inventory replenishment policies with the utilization of mathematics, algorithms, or simulation method to search for the parameter values. However, the process of finding the parameters values through mathematical model or algorithm is so complicated. that is could be rather difficult for nurses responsible for medical material management to implement those proposed replenishment policies and algorithms.Different typical inventory replenishment models, the Theory of Constraints (TOC) suggests a simple buffer management model with Demand-Pull management concept to overcome these shortcomings. This study proposes a Dynamic Drum-Buffer-Rope (DDBR) method that is based on the buffer management model to facilitate medical material management. The DDBR method employs the System Dynamics approach to conduct simulations and experiments to support the design of the medical material management policy. Also, in the research, the DDBR method is applied to a teaching hospital to illustrate the benefit, and the results show that both inventory levels and out of stock situation are improved to enhance the validation of the DDBR method.
