Nowadays, the hospital managers are facing increasing financial difficulties, because of the global budget policy from the national health institute. Patient-oriented services, good manner of the care providers, and the rapid response of the hospital to the medical environment are among the important factors for hospital survival. Therefore, many medical care providers had designed the clinical pathway for standardized medical treatment to control the medical costs, but they also allowed some extra-services for attracting and recruiting more patients. In this study, by way of participating management and job enrichment, we try to improve the quality and the patient satisfaction of the pelvic sonography provided by Obs/Gyn department. The study was proceeded in 2 ways. First, we designed a standardized obstetrical and gynecological sonography service pathway, which include a standard flow chart, customer encounter, and a checklist. Second, we measured the total service time duration, including those of pre-service consultation, actual sonography performing, and the post-service consultation. The measurements were performed before and after the application of the standardized sonography pathway. The measurement results were used to analyze and evaluate the validity and efficiency of the originally designed pathway. The study results demonstrate that after application of the sonography pathway, the total service time duration is reduced in Gyn sonography, but increased in Obs sonography. For Gyn sonography, the duration of pre-service consultation and post-service consultation were significantly reduced after application of standardized pathway. Further analysis revealed that thorough pre-service consultation not only made our patients more comfortable, but also reduced the post-service consultation time. However, the actual sonography performing time was increased, because of the adding of the standardized conversation. For obstetrical sonography, the duration of the actual sonography performing time was decreased, possibly due to the adding of standardized conversation, which answered most of the questions that the pregnant patients want to know about. In conclusion, by way of establishment and repeated reassessment/correction of the standardized sonography pathway, the quality of the sonography services can be greatly improved, and the patient¡¦s satisfaction can be even greater. The same experience can be applied to other fields. The quality of medical care can be more stable by the application of standardized clinical pathway. Besides, through the efforts of quality control, the medical cost can be limited, and the financial burden of the hospital and medical care providers can be reduced, making a double-win medical environment. Key Word: service pathways,total service, Obs/Gyn sonography

Introduction The number of the people who needs dialysis escalates rapidly year each. The rising cost of dialysis is relative. Because Bureau National Health Insurance endures the co-payment of hemodialysis, patients have freedom of choice. Two critical factors that influence patient¡¦s decision in medical care are access and quality. Facing pressure from competition, many hemodialysis service providers believe that high quality service will retain patients to return as well as maintain a healthy physician-patient relationship. Therefore, they apply many quality management tools, which also include service pathways. There are few investigations that discuss service pathways. Thus, this research constructs a model to analyze the effect of service pathways in hemodialysis service providers. Method From Nov. 1, 2003 to Dec. 31, 2004, the researcher interviewed hemodialysis nurses to develop flow chart, customer encounter, and check list for hemodialysis. We also collected the check list records of the hemodialysis patients to examine the effect. Conclusion First, the construction of total service pathways comprised three critical interlocking phases: flow chart, customer encounter, and check list. After that we shall evaluate and correct them continuously. Secondly, the researcher found that most patients are routine members, and come from long-term care center and respiratory care ward (RCW). Thirdly, the indicators influencing hemodialysis results and error incidents were steady. Finally, in the value-added services dimensions, the indicators of nurses¡¦ performance on greeting and asking patients if they want to have a meal were significant, but the indicators of telephone and inpatient interview were unfavorable.