區域醫院醫療爭議事件精進策略-以Ｔ醫院Ｙ分院為例

醫療爭議以往稱作醫療糾紛長久以來就是醫療人員的夢靨，醫病關係惡化、患者意識高漲與醫療知識的不對等，都是會因為誤解而產生醫療糾紛的原因之一。一旦發生不僅造成醫病關係的緊張，也衝擊醫療生態與醫療執業行為的改變，雙方皆無益；甚至增加社會成本，盡是三輸。如何避免、保障醫師救人熱情、考量家屬與病患權利達雙贏，是目前醫界重要的課題本文主旨在精進偏鄉地區區域醫院醫療糾紛事件的因應策略。它提出了幾項精進策略建議，包括建立一個積極找出潛在醫療糾紛的文化；使用各項培訓來加強醫事人員早期醫療糾紛的發現和預防的能力；以及教育第一線醫事人員的調解與溝通能力，以減少誤解和因溝通衍生的問題。論文強調了精進醫事專業人員與患者之間溝通的重要性，以及對醫事專業人員進行持續教育和培訓以提高其溝通與法律知識的必要性。論文提出精進策略的主要概念是利用CSOP（文化、策略、組織、人員）框架，從文化、策略、組織、人員四個面向來分析和規劃如何在既有的策略上，更佳提升來預防醫療糾紛。此框架透過四個關鍵領域來分析和規劃如何精進目前預防醫療爭議的流程並建立新的預測模式。在文化上，於醫療機構內，建立尊重、公平、透明、不責難的文化，包括鼓勵醫事工作人員和患者之間的開放式溝通，主動通報並創造一個可以安全地討論和解決錯誤的環境。在策略上，制定防止爭議發生的因應策略，並為爭議發生時的處理提供明確的指導方向與流程。在組織上，建立有效的組織運作架構，確保醫療爭議的管理流程能順利運作；包括專門的爭議解決團隊、跨部門的協調機制以及明確的職任分工。在人員上，對員工進行溝通、爭議解決及情緒管理技巧的課程訓練。此案例自108年開始進行一連串的精進措施並與醫院品管單位於111年一同規劃設置了預警通報系統，期能在更早發現徵候，更及早處理，以避免可能的爭議事件發生。結果顯示，逐年增加通報數，增加了協調溝通次數，並未增加訴訟案件。數位化後的通報系統可以增加通報量，也提供高的滿意度。多元的課程模式可以提高學習動機與效果。

關鍵字

醫療爭議；ＣＳＯＰ框架；醫療糾紛

並列摘要

Medical disputes, previously known as disagreements in healthcare, generate stress for providers and can worsen doctor-patient relationships, enhance patient awareness, and exacerbate the knowledge gap between patients and healthcare professionals. These issues not only lead to tension but also shift medical practice dynamics and increase social costs. To combat this, the paper highlights strategies to avert such disputes, especially in underserved rural areas. It promotes the development of a culture that proactively identifies and addresses potential disputes early on, and it underscores the importance of training to enhance the communication and mediation abilities of frontline medical staff, aiming to cut down on misunderstandings and issues arising from communication failures. The paper advocates for improved communication between healthcare providers and patients, as well as continual education and training to advance the clinical and legal skills of healthcare professionals. The strategies are structured around the CSOP framework, which encompasses Culture, Strategy, Organization, and Personnel. The ‘Culture’ aspect underlines the importance of cultivating an atmosphere of respect, fairness, transparency, and accountability within medical institutions. It encourages open dialogue and a safe space for discussing and resolving errors without the threat of repercussions. The ''Strategy'' facet focuses on creating preemptive measures for disputes and clear guidelines for their resolution. ''Organization'' advises establishing solid organizational frameworks for efficiently managing medical disputes, potentially involving specialized resolution teams and clear responsibility divisions. The ''Personnel'' section emphasizes the need for staff training in critical skills like communication, dispute resolution, and emotional management. The CSOP framework suggests a comprehensive approach to preventing medical disputes by focusing on these four key areas. Such strategies aim to create a more harmonious healthcare environment, reduce disputes, and keep the focus on patient care and safety. The ultimate goal is to achieve a win-win situation where healthcare professionals'' dedication to saving lives is matched by the protection of patients and their families'' rights and interests. In conclusion, the paper offers a detailed and practical framework for reducing medical disputes in rural healthcare settings. Through the CSOP framework, healthcare institutions can systematically enhance the environment for both providers and patients, supporting the vital work of healthcare with a strong, communicative, and empathetic foundation.