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題名:醫療服務失誤類型與趨勢分析:以地方法院判決文為例
作者:郭淑珍
作者(外文):Kuo, Shu Chen
校院名稱:亞洲大學
系所名稱:經營管理學系
指導教授:邱文宏
陳世良
學位類別:博士
出版日期:2016
主題關鍵詞:醫療糾紛服務失誤醫療服務失誤內容分析法Service failuresmedical service failurescourt judgmentcontent analysis
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因醫療服務失誤衍生醫療糾紛案件日益增加,國內外皆然,故如何避免發生醫療服務失誤成為重要的課題;過去少有研究以病患的觀點探討醫療服務失誤,本研究目的旨在分析司法院法學資料庫之醫療糾紛判決文,以醫療受服務者(即原告)觀點探討發生醫療服務失誤的類型。本研究力求內容嚴謹度,採二階段模式進行,第一階段進行預試研究 (pilot-study) 分析333例,第二階段1998-2014年分析醫療糾紛998例,分析架構以醫療服務失誤性質(技術面、組織面)與醫療服務失誤方式(直接關係、間接關係)之二維矩陣四構面分析策略,將醫療服務失誤事件歸納為四構面,共分析獲得2887件失誤、13項子類、40項細類,並針對研究結果進行專家深度訪談,最後獲得以下研究發現:一、整體醫療服務失誤以技術性醫療失誤高於組織性醫療失誤,且各層級醫療院所亦以技術性醫療失誤高於組織性醫療失誤;二、技術性醫療實務以術產施行失誤、診斷失誤、用藥失誤較高,而技術性醫療支援失誤以醫病溝通失誤、專業警覺性不足較高;三、技術性醫療實務失誤、組織性醫療支援失誤呈遞減趨勢、組織性醫療實務失誤成倒U型,惟技術性醫療支援失誤大幅遞增;四、醫療服務失誤子類事件,6項失誤呈遞減趨勢、4項失誤呈遞增趨勢。本研究結果,可作為臨床醫療人員於執行醫療相關業務之警惕,與管理者制定實施醫療照護法律相關教育課程之參考,期能降低醫療服務失誤進而提升醫療品質與病人安全。
As the cases of medical malpractice derived from the failure of medical service, both domestically and abroad alike, increased as the days go by. Therefore, how to prevent medical errors is an important issue.Past studies rarely emphasized medical service failure (MSF) based on patients’ viewpoint and also rarely developed prevention strategies based on patients’ perspective. The objective of this research is to analyze the Judicial Legal Information Retrieval System of Medical Malpractice verdict, to discuss the categories of medical failure that took place based on the standpoint of the one who received medical service (namely the plaintiff). In order to have strict accuracy content, this research will be proceeded by adopting two stages model. First stage is to proceed with pilot-study, to analyze 333 cases, and second stage is to collect 998 cases of medical Malpractice from years 1998 to 2014, to adopt content analysis method and utilize content analysis method to categorize and to induce to interpret the reason that causes medical dispute. By the analytical structure, the research analyzes the strategy of four aspects of two dimensional matrices within nature of MSF (namely technoical and organizational aspects) and method of MSF (namely direct relationship and indirect relationship) to induce medical MSF incidents into four aspects, and the analysis results in 2887 cases of MSF, 13 items of sub-categories, and 40 items of detailed-categories. The findings are: I. Overall, Regarding to all of the MSF, technoical aspect of medical service is higher than organizational aspect of medical service, and all levels Medical institutions also technoical aspect of medical service is higher than organizational aspect of medical service. II. Technoical aspect of medical service in failure of during surgical labor procedure, and diagnosis error; Medication errors is higher; technoical aspect of medical support and failure during failure in professional awareness and communication failure. III. Followed by Three Stages Trend Analysis, failure in technoical aspect of medical practice, failure in organizational aspect of medical practice, and failure in organizational aspect of medical support appeared to have trend of decrease progressively, only failure in technoical
aspect of medical support is increasing progressively by great margin. (IV) After further inspecting Medical service failure event of sub-categories, a 6 items of failure appeared to decrease progressively; only treatment, insufficiency in professional awareness; communication during medical treatment, post surgical care of the 4 failure items appeared to have the trend of increasing progressively. The result of this research can be used by the clinical medical staffs as a warning and a prevention of occurrence of MSF during execution of medical practice, and also to provide as a reference for the manager who is drafting related educational courses on the laws of medical care practice, hopefully to reduce the MSF during medical treatment and increase on medical care quality and the safety of the patient.
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