在醫療服務具有高度不確定性與個案差異性的情況下，醫療服務項目組合的穩定性可能與醫療服務效率及醫療品質具關聯性。過去醫療管理文獻多著重於聚焦程度、經驗累積或專業化對醫院績效之影響，較少探討醫療服務聚焦狀態在不同期間的變動。本研究以台灣南部一所區域教學醫院 2022 年至 2024 年之醫療服務資料為樣本，探討醫療服務聚焦的變異性與醫療服務效率及品質結果之關聯。主要自變數為醫療服務聚焦的變異性，用以衡量醫療服務項目組合的變異程度；主要應變數為醫療服務執行時間偏差與病患住院天數。此外，進一步檢視醫療服務聚焦的變異性與病患重返、死亡與感染等醫療品質之關聯性。
實證結果顯示，醫療服務聚焦的變異性與醫療服務執行時間偏差及病患住院天數皆呈顯著正相關，表示當醫療服務項目組合之變動程度較高時，醫療服務執行時間偏差較大，病患住院天數亦較長；品質相關結果的分析顯示，醫療服務聚焦的變異性與病患重返及死亡呈現正相關，但其與病患感染則未達顯著水準。額外分析與穩健性測試大致支持主要結果，顯示醫療服務聚焦的變異性與醫療服務效率及部分醫療品質結果具有一定關聯。本研究從聚焦狀態是否穩定的角度補充醫療聚焦相關文獻，並為醫療機構評估醫療服務項目組合與流程穩定性提供參考。

Given the uncertainty and heterogeneity inherent in healthcare delivery, the stability of the clinical service mix may have important implications for both healthcare efficiency and quality of care. Prior studies have examined hospital performance mainly from the perspectives of focus, experience accumulation, and specialization, but have paid less attention to whether clinical service focus remains stable over time. Using clinical service records from a regional teaching hospital in southern Taiwan from 2022 to 2024, this study examines the association between variability in clinical service focus and healthcare efficiency and quality outcomes. The main independent variable is variability in clinical service focus, which reflects the stability of the mix of clinical services. The main dependent variables are clinical service execution time deviation and length of stay, while readmission, mortality, and infection are further examined as quality of care.
The empirical results show that variability in clinical service focus is positively associated with both execution time deviation and length of stay. These findings suggest that a less stable clinical service mix is associated with larger deviations between estimated and actual execution time and longer patient stays. Additional analyses indicate that variability in clinical service focus is positively associated with readmission and mortality, whereas its association with infection is not statistically significant. Further analyses and robustness tests generally support the main findings. Overall, this study contributes to the healthcare operations literature by shifting attention from the degree of focus to the stability of focus, suggesting that variability in the clinical service mix is associated with lower efficiency and quality of care.

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