隨著醫療服務型態的改變,醫療機構組織管理的重要性日增,如何妥善使用醫療儀器,並整合醫療體系中各部門的運作,避免因儀器設備有所缺失,或是專業人員之間溝通不良,以致病人發生損害,便益形重要。醫院管理領域中著名的「瑞士乳酪理論(Swiss cheese model)」,便是由組織的角度進行剖析,探討現代醫療機構高度分工下可能衍生的副作用。然於我國現行學說與法院實務,醫療機構民事責任的成立與否,關鍵仍繫於個別醫事人員於執行醫療相關行為時有無故意過失,易言之,無論是契約責任或是侵權責任,醫療機構皆等同是「為個別醫事人員的行為負責」,並非為機構本身的組織管理行為而負責。本文將引用外國法做為借鏡,嘗試於我國既有法體系之下,針對醫療機構民事責任進行完整的建構,繼而以我國法院的實務判決做為主要的研究素材,歸納出醫療機構可能負有的組織義務型態,提供做為課與醫療機構組織責任的依據。
With the change of the patterns of medical service, organizational management of the medical institution becomes increasingly important. By adequate use of the medical devices and integrating teamwork, some hazards and catastrophic events might be preventable. According to the well-known “Swiss cheese model”, the system approach could be an effective way in error management. However, in our legal system, the personal approach is still the mainstream of ordinary civil liability, either contractual liability or tort liability. In this article, we try to construct the organizational liability of the medical institution in our legal system by adopting the theories in German and American law. Besides, we also enrich the contents of the duty of organizational management with the empirical study of our court decisions.