建立醫療組織倫理評鑑標準之初探

An attempt at the establishment of healthcare organization ethics accreditation standards

吳敏華(Min-Hua Wu)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2008年)

摘要

本研究之目的在於回顧國外醫療組織倫理評鑑標準沿革、內容及實施現況，並評估國內建立醫療組織倫理評鑑標準之可行性，建立相關評鑑標準，研究結果可作為衛生主管機關擬定或推行評鑑制度之參考。
本研究自執行以來，除進行國內外文獻收集，初步整理出美國、英國、紐西蘭、法國等地的醫療組織倫理推行現況，藉以形成評鑑標準草案。其後邀請國內公民營機構及醫院等專家，舉辦二次座談會議，進行兩回合書面往返德菲法（Delphi Method）修改草案內容。
最後將凝聚專家意見而成的草案編彙為研究問卷，由於問卷內容經過德菲法的審查，已具良好效度；再經過重測信度的測試，發現信度亦佳。使用郵遞問卷進行調查，研究對象為全國評鑑合格之497家醫院，共計回收90份有效樣本，回收率為18%，藉由問卷的分析結果與回饋意見，瞭解醫療機構管理者對相關評鑑制度的看法與建議，以完備草案內容，進而促進我國醫學倫理之實務發展與具體實踐。
本研究研擬之醫療組織倫理評鑑標準，可分為以下六大部分：
ㄧ、醫療組織倫理政策規範與領導
二、醫學倫理委員會的成立與運作
三、研究相關倫理委員的成立與運作
四、醫學倫理教育
五、組織倫理氣候
六、尊重病人權利及建立良好醫病關係
另綜合開放意見，有以下幾點建議：一、因各層級醫院任務不同，可能需要分層級適用本標準。二、「組織倫理氣候」此一概念，多數受訪者不甚暸解其意涵，因此在醫學倫理教育訓練時，可再多著墨。三、本研究現階段僅研擬出評鑑基準，建議日後研究者可再進ㄧ步研擬醫療組織倫理評鑑標準之評分說明。

關鍵字

醫學倫理 ； 組織倫理 ； 評鑑

並列摘要

The purposes of this study are to review the international literature regarding the evolution, content and practice of healthcare organization ethics accreditation standards, to evaluate the feasibility of establishing healthcare organization ethics accreditation standards in Taiwan, and to draft the accreditation standards. The research results can be used as a reference for health authorities to set up or promote the accreditation system.
During the first stage of this study, we had collected information from the United States, United Kingdom, New Zealand, and France etc, in order to formulate the initial draft of the accreditation standards. Then, we invited local experts from both public and private institutions and hospitals to attend two focus group meetings, and conducted two rounds of communication via the Delphi Method to modify the content of the draft.
Finally, the modified draft was transformed into a questionnaire which had acceptable expert validity and test-retest reliability, and was used in the subsequent mail survey. The target subjects of the questionnaire survey were the 497 accredited hospitals. 90 valid responses were received, and the response rate is 18%. Through the analyses of the results and feedbacks, we were able to gather the views of the leadership of healthcare institutions.
The final recommended draft of healthcare organization ethics accreditation standards encompasses six parts as the following:
1. Policies, bylaws and leadership for healthcare organization ethics.
2. The formation and operation of hospital medical ethics committees.
3. The formation and operation of research ethics related committees.
4. Medical ethics education.
5. Organizational ethical climate.
6. Respect patient rights and establish good patient-physician relationships.
Further suggestions drawn from feedback opinions are as follows. Firstly, since hospitals of different accreditation levels have different missions, these ethics standards might have to be stratified accordingly in application. Secondly, since most respondents do not understand the concept of “organizational ethical climate”, more education on this subject is needed. Thirdly, this study only proposes the accreditation standards and more researches in establishing scoring criteria for the standards need to be done.

並列關鍵字

medical ethics ； organizational ethics ； accreditation

參考文獻

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蔡甫昌、謝博生(2003)。醫師專業精神與醫療組織倫理。台灣醫學，7(4)，587-601。

蔡甫昌、謝博生(2004)。衡量與卓越之間總額預算下的醫療組織倫理。健康世界，227:6-12。