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

The range of definitions involving ¡§service¡¨ is wide. For example, plumbers or lawyers offer technique or profession; consultants or teachers offer knowledge or information; meeting room or car rental agencies as well as people in movie industries offer facilities or space. Of course, a particular place like a hospital provides more than one service, including profession, skills, knowledge, space, etc. In Taiwan, the employment rate in service industry reached 50.2% in 2000. It was the first time the percentage exceeded the one in labor industry, and it is increasing gradually every year. The development of service industry is predicted to influence the economy in the future. The most important factor in service industry is the quality of service. Some even connect service quality with customer satisfaction as well as employees¡¦ rewards. Medical care is a kind of service, too. However, the complication and variation make it hard to measure the quality, especially when it is related to the quality of technique (result). The researchers have a lot of issues about the structures of service quality. In the earlier documents, people agreed with using SERVQUAL to measure the quality. However, European scholars have considered other aspects of service quality. They pointed out that there should be three aspects of service quality for customer satisfaction, including functional (procedure), technological (result), and impressional (image), etc. Although most of the scholars agreed that service quality has multi-structures, they don¡¦t have the same opinion about the essence and the content of it. In Taiwan, most of the people who study for the quality of medical service adopt the theory of P.Z.B. However, my report is trying to use Ward et al (2005) to study the chart of medical service quality. This is to test if the medical service quality of a particular clinic meets the expectation, then we can analysis the relationship of overall quality (patients¡¦ satisfaction) and service quality. Thus we can establish the pattern of prediction, and provide the particular clinic with the references to evaluate the medical service quality. China Steel established a particular clinic in order to respond to ¡§Employee Health Protection Regulation¡¨. The aim of having this clinic is to take care of the employees¡¦ health. The first priority is to provide the basic medical service for them. China Steel has about 8600 employees. The market has about 30 thousand people, including sub-manufacturers and families. Therefore, the clinic is designed to be much bigger than the average ones, and it has 24 staff. This clinic doesn¡¦t have to be responsible for whether it is making money or not. The results of service became the only standard to evaluate the operation. The development of pattern for measuring service quality is necessary for evaluating the results of it. In addition, it can be used to improve the service and promote the welfare of the employees¡¦ physical and mental health.

Thèse doctorat : Qualité : Villeurbanne, INSA : 2004. / Titre provenant de l'écran-titre. Bibliogr. p. 193-213.

Thesis (doctoral)--Universiteit Leiden, 2008. / Description based on print version record. Includes bibliographical references (p. 233-244).

Thesis (M. Sc.)--University of Hong Kong, 1992. / Includes bibliographical references (leaves 124-127).

Thesis (M.S.W.)--University of Hong Kong, 1975.

Thesis (M.S.W.)--University of Hong Kong, 1982.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1982.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1983. / Typescript.

Thesis (M.S.W.)--University of Hong Kong, 1985. / Photocopy of tyepscript.