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題名：邱小妹人球案之評析：高可靠度組織理論的觀點
書刊名：中華行政學報
作者：葉嘉楠 引用關係
作者(外文)：Yeh, Chia-nan
出版日期：2011
卷期：8
頁次：頁261-279
主題關鍵詞：高可靠度組織；邱小妹人球案；醫療體系；全民健康保險；High reliability organization；Little girl Chiu's case；Medical system；National health insurance
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94年1月10日，因家暴受虐的邱小妹被台北市立聯合醫院仁愛院區轉診至台中治療，由於延誤醫療時機而後導致死亡，進而引發輿論強烈的抨擊。本文從高可靠度組織理論來探討此一事件。高可靠度的組織是指是指組織在長時間表現出高可靠度，避免出現某種對監督者而言是無法接受的意外及後果。高可靠度組織理論有四個原則。一、政治及組織領導人以安全作為優先考量的承諾。二、組織內與組織間的功能重疊。三、在組織內產生高可靠的文化。四、強調組織學習的價值。在邱小妹人球案這個事件中，各大醫院隱匿病床、EOC電話斷線的疏忽、轉診制度程序不清、林致男醫師未親自看診又竄改病例、劉奇樺醫師知情又包庇、醫師值班時間過長、及健保制度扭曲誘因結構等是造成邱小妹人球案悲劇的原因。這些問題突顯出我國健保制度與醫學教育多年的沈珂，而這些問題是可以透過高可靠度組織理論加以改進的。
The little girl Chiu's case caused a public uproar after media reports that she was forced to be transferred more than 100 kilometers for emergency treatment in Taichung. The purpose of study is to evaluate Chiu's case through the high reliability organization (HRO) perspective. HRO refers to failure-free operation in large organizations that attempt to perform demanding tasks with little margin for error. There are four principles that must be adhered to in order to ensure reliable management. The first is a commitment by political and organizational leaders to make safety a very high priority. Second, HRO needs redundancy within and between organizations. A third tenet of HRO is the creation of a culture of reliability within an organization. The final element of HRO is the value of organizational learning.The causes of Chiu's case are: (1) 19 hospitals lied about the information of empty beds. (2)Neurosurgeon Lin did not see the little girl personally and changed the clinical records. (3) EOC failed to connect available hospital with empty beds. (4) Doctor's negligence due to overworking. (5) Many hospitals are unwilling to take patients in need of emergency treatment because the medical payment by NHI program cannot cover the hospital's cost. All these problems violate the principles of high reliability organization.
期刊論文
1.Sagan, Scott D.(1994)。Toward a Political Theory of Organizational Reliability。Journal of Contingencies and Crisis Management，2，228-240。  new window
2.LaPorte, Todd R.(1996)。High Reliability Organizations: Unlikely, Demanding and at Risk。Journal of Contingencies and Crisis Management，4(2)，60-71。  new window
3.LaPorte, Todd R.(1994)。A Strawman Speaks Up: Comments on Limits of Safety。Journal of Crisis and Contingency Management，2，207-211。  new window
4.Roberts, Karlene H.(1990)。Some Characteristics of One Type of High Reliability Organization。Organization Science，1(2)，160-176。  new window
5.Perrow, Charles(1994)。The Limits of Safety: The Enhancement of a Theory of Accidents。Journal of Crisis and Contingency Management，2(4)，212-220。  new window
6.Weick, Karl E.(1987)。Organizational Culture as a Source of High Reliability。California Management Review，29(2)，115-128。  new window
7.Frederickson, George H.、La Porte, Todd. R.(2002)。Airport Security, High Reliability, and the Problem of Rationality。Public Administration Review，62，33-43。  new window
8.LaPorte, Todd R.、Consolini, Paula M.(1991)。Working in Practice But Not in Theoiy: Theoretical Challenges of High-ReliabiIity Organizations。Journal of Public Administration Research and Theory，1，19-47。  new window
9.Roberts, Karlene(1990)。Managing High Reliability Organizations。California Management Review，summer，101-113。  new window
10.Roberts, Karlene、Bea, Rovert(2001)。Must Accidents Happen? Lessons From High-Reliability Organizations。Academy of Management Executive，15(8)，70-79。  new window
研究報告
1.Marais, Karen、Dulac, Nicholas、Leveson, Nancy(2004)。Beyond Normal Accidents and High Reliability Organizations: The Need for an Alternative Approach to Safety in Complex Systems。  new window
學位論文
1.Libuser, Carolyn(1994)。Organization Structure and Risk Mitigation。  new window
圖書
1.Weick, Karl E.、Sutcliffe, Kathleen M.(2001)。Managing the Unexpected: Assuring High Performance in an Age of Complexity。Jossey-Bass Inc.。  new window
2.Perrow, Charles(1984)。Normal Accidents: Living with High-Risk Technologies。New York, NY：Basic Books。  new window
3.Morone, Joseph、Woodhouse, Edward(1986)。Averting Catastrophe: Strategies for Regulating High Risky Technologies。Berkeley：Los Angeles：University of California Press。  new window
4.Perrow, Charles、蔡承志(2001)。當科技變成災難--與高風險系統共存。台北：商周。  延伸查詢new window
5.Wildavsky, A. B.(1988)。Searching for Safety。New Brunswick, NJ：Transaction Publishers。  new window
6.Bendor, Jonathan B.(1985)。Parallel Systems: Redundancy in Government。CA：The University of California Press。  new window
7.Clark, Lee(1989)。Acceptable Risk? Making Decisions in a Toxic Environment。Berkeley。  new window
8.Dynes, R.R、Tierney, K. J,、Fritzs, C.E.(1994)。Disaters, Collective Behaviors, and Social Organization。Newark, Delaware。  new window
9.Sagan, Scott D.(1993)。The Limits of Safety: Organizations, Accidents, and Nuclear Weapons。Princeton。  new window
10.Short, James、Clarke, Lee(1992)。Organizations, Uncertainties, and Risk。San Francisco。  new window
11.Moe, Terry M.(1990)。The Politics of Structural Choice: Toward a Theoiy of Public Bureaucracy。Organization Theory。New York。  new window
其他
1.中國時報民意調查組(2005)。沒病床，58％走後門，臺北。  延伸查詢new window
2.王鵬惠(2005)。國際醫學期刊：醫師超時值班睡眠不足，和酒駕一樣危險，臺北。  延伸查詢new window
3.吳喬治(2005)。醫界公開的秘密：招無住院醫師，護理師代值，臺北。  延伸查詢new window
4.何博文(2005)。監委透露：EOC出現嚴重瑕疵，臺北。  延伸查詢new window
5.沈希哲(2005)。緊急應變，係依經驗臨場判斷，臺北。  延伸查詢new window
6.李樹人(2005)。邱小妹的遺產，臺北。  延伸查詢new window
7.林萍章(2005)。終於承認：醫療體制有缺失，臺北。  延伸查詢new window
8.韋麗文(2005)。面在害怕，急診效率就變快，臺北。  延伸查詢new window
9.鄭心媚(2005)。仁愛院區：四通關鍵電話，決定轉診台中，臺北。  延伸查詢new window
10.鄭心媚(2005)。小醫師成箭靶，制度檢討在哪，臺北。  延伸查詢new window
11.鄭心媚，楊國泓(2005)。保制度，影響國内醫療環境，臺北。  延伸查詢new window
12.謝金河(2005)。邱小妹事件：制度面與人性面，臺北。，http://www.pts.org.tw/php/news/facecountry/view.php?XSSENO=93&PRINT=1。  延伸查詢new window
13.薛桂文(2005)。特殊科別、病房 須專科醫師坐鎮，臺北。  延伸查詢new window
14.吳慧芬(2005)。腦傷給付低，醫院不愛收，臺北。  延伸查詢new window
15.劉開元(2005)。沒病床？北市去年800多人受誤，臺北。  延伸查詢new window
16.劉存厚(2005)。人球案，壓垮健保的最後一根稻草，臺北。  延伸查詢new window
17.廖訓禎(2005)。從邱小妹妹醫療事件看台灣的轉診制度，臺北。  延伸查詢new window
18.胡恩蕙，林進修，林秀美，詹建富(2005)。醫師負荷大，醫療品質如何提升，臺北。  延伸查詢new window
19.Roberts, Karlene(2003)。HRO Has Prominent History，http://www.gasnet.org/societies/apsf/newsletter/2003/spring/hrohistory.htm。  new window
圖書論文
1.Woodhouse, E. J.(1990)。Sophisticated Trial and Error in Decision Making About Risk。Technology and Politics。Durham：Duke University Press。  new window
 
 
 
 
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