邱小妹人球案之評析：高可靠度組織理論的觀點

Evaluating the Hospital Scandal of Battered Girl Chiu: A High Reliability Organization Perspective

葉嘉楠(Chia-Nan Yeh)

《中華行政學報》 8期 (2011/06) Pp. 261-279

https://doi.org/10.6712/JCPA.201106_(8).0013

摘要

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。

關鍵字

高可靠度組織 ； 邱小妹人球案 ； 醫療體系 ； 全民健康保險

並列摘要

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.

並列關鍵字

High reliability organization ； Little girl Chiu's case ； Medical system ； National health insurance

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