醫療風險管理及危機處理

Medical Risk Management and Crisis Response

王怡人(I-Jen Wang) ； 徐錦池(Jiin-Chyr Hsu)

《醫學與健康期刊》 8卷1期 (2019/03) Pp. 115-130

摘要

隨著科技社會的複雜化，危機的發生率與嚴重性與日俱增，從921地震、莫拉克颱風、SARS、H1N1流感大流行到食安事件等，對於社會安定造成嚴重的負面影響，各種天然與人為災害引發的重大危機，不斷考驗著臺灣醫界的危機應變能力。做好準備及提升緊急應變能力，是醫界所面臨的重要挑戰。除自然災害外，醫院可能發生的風險還包含財務管理風險、人力資源風險、醫院信譽風險、品質經營風險、自然災害風險。危機一旦發生，將衝擊醫院平時所建立的作業流程，常難以整合，容易延誤化解危機的最佳時機。若醫院事先做好風險管理，危機發生時能在極短時間作出妥適的危機決定，成立危機處理小組，制定危機處理方案並即時採取有效行動，進行有效的危機溝通，便可舒緩危機的威脅，甚至化解危機。常見議題包括風險發生的機率多大？風險的危害多嚴重？風險值如何計算？如何預防控制降低風險？如何做危機處理及溝通？本文將針對這些議題逐一介紹，並以病人安全、全人整合照護及醫糾早期警示，當實例討論。

關鍵字

風險管理 ； 危機處理 ； 緊急應變 ； 病人安全 ； 全人整合

並列摘要

With the coming of complex societies, the incidence and severity of the crisis are increasing daily. Various natural and artificial crises such as the 921 Earthquake, Typhoon Morakot, SARS, H1N1 influenza pandemic, food contaminated events, and etc. have had a serious adverse impact on our social stability. These disasters keep challenging the crisis response capabilities of the hospitals in Taiwan. Preparing and improving emergency response capabilities are important challenges faced by the hospitals. In addition to natural disasters, risks that may occur in hospitals include financial management crisis, human resource crisis, business quality crisis, and medical dispute credibility crisis. Once a crisis occurs, it can challenge the hospital's established operating processes. It is often difficult to integrate the challenges into the whole process, leading to delays in resolution of the crisis. If hospital decision-makers conduct risk management in advance, make a crisis decision promptly when a crisis occurs, set up a crisis management team, develop a crisis management plan, and perform effective crisis communication, the threat of crisis can be eased and possibly resolved. The key topics for risk management include the following: the likelihood of risk, the danger of risk, the calculation of risk, the prevention, control, and reduction of risk, communicating possible risk and handling crisis. This article will discuss these issues using patient safety, holistic health care, and early warning of medical disputes as examples.

並列關鍵字

Risk management ； Crisis management ； Emergency response ； Patient safety ； Holistic health care

參考文獻

李順安：醫療院所的品質及危機管理。臺灣醫界2003；46。Available at: http://www.tma.tw/magazine/magazine_ShowRepID.asp?/1292.html Accessed May 7, 2018。Lee SA: Quality and crisis management of hospitals. Taiwan Medical Journal 2003;46. Accessed May 7, 2018. [In Chinese]

國家文官學院：公務人員考試錄取人員基礎訓練：危機管理(含案例[與實作)。Available at: http://www.nacs.gov.tw/NcsiWebFileDocuments/5c2c09453a2c7382c822f62071dbd77e.pdf. Accessed May 1, 2017。National Academy of Civil Service: Civil service examination admission basic training: crisis management. Available at: http://www.nacs.gov.tw/NcsiWebFileDocuments/5c2c09453a2c7382c822f62071dbd77e.pdf. Accessed May 1, 2017. [In Chinese]

台灣醫事檢驗學會：以風險管理流程建置品質管制。Available at: http://www.labmed.org.tw/Upfiles/Test_5A/2014102192438.pdf Accessed July 15, 2018. Taiwan Society of Laboratory Medicine: Yi Feng Xian Guan Li Liu Cheng Jian Zhi Pin Zhi Guan Zhi. Available at: http://www.labmed.org.tw/Upfiles/Test_5A/2014102192438.pdf Accessed July 15, 2018. [In Chinese]

宋明哲：現代風險管理。第一版。臺灣：五南出版社，2001。Sung MC: Management Series. 1st ed., Taipei: Wunan, 2001. [In Chinese]

Mitch Saruwatari: Conducting a Hazard and Vulnerability Analysis. Available at: https://www.ecri.org/EmailResources/Conferences/NASRM/Session%205b%20Hazard%20Vulnerability%20Assessments%201%20slide%20pp.pdf Accessed May 7, 2018.