論病人安全文化對醫療體系的衝擊

The Impact of Patient Safety Culture on the Medical System

顏如娟(Ju-Chuan Yen) ； 許明暉(Min-Huei Hsu)

《北市醫學雜誌》 5卷2期 (2008/04) Pp. 173-184

https://doi.org/10.6200/TCMJ.2008.5.2.01

摘要

“病人安全”是一項跨世紀的醫療改革運動，在美國與歐洲、澳洲均如火如荼地展開，就連世界衛生組織(World Health Organization)也在其網站上發表一些有關病人安全的原則與恰當的措施，而這一切要從美國醫療協會(Institute of Medicine)出版《凡人皆可能犯錯》(”To Err Is Human”)一書談起，該協會受美國聯邦政府所託付，期待能發展出在未來十年，達成促使醫療照護品質實質進步的政策，此委員會的成員成功地運用了幾個醫療失誤事件，讓人有怵目驚心又感同身受的體認；於是，病人安全就在跨越第二個千禧年的十年醫療改革運動中喊得震天價響，成為標幟鮮明的口號，醫療主事者皆能朗朗上口，就此點而言，美國醫療協會的操作是成功而且令人印象深刻的。但是，就廣泛的定義而言病人安全是提升醫療品質的醫療改革運動中的一部分，而病人安全這樣的運動，美其名為一種醫療改革，以求達到高醫療品質的目標，就醫療史與社會學的角度來看，這也是另一種程度的社會控制，為求達到一種標準化與規格化的醫療照護水準，在美國如美國醫院評鑑系統(Joint Commission Accreditation of Healthcare Organization, JCAHO)將病人安全的成效落實至實務的評鑑標準中，並將醫療費用藉此名目納入管理，以達成樽節醫療支出，同時又可經由一種標準化的規範或可達成醫療體系的科層化架構加以鞏固，自醫療體系外部加以管控，達成社會控制的目的。在這當中，我們看到了因為醫療品質未臻完善而引起許多巨觀與微觀層面的損失，甚至連國民生產毛額損失亦被提及，醫療體系彷彿不再是上可醫國、下可醫人的救星，霎時間，醫療體系宛若千夫所指全民公敵一般，這樣的衝擊是本論文探討的主題。病人安全運動包涵範圍十分寬廣，本文會做一簡單介紹，並從社會主義與醫學史角度予以檢視此種文化對醫療體系的衝擊，以便醫療人員能有足夠的認知與心理準備，以免讓這股被形容為世紀大海嘯的跨世紀醫療改革運動淹沒而萬劫不復，甚至可以超越過去，讓醫療照護品質達到更好更進步的理想境界。

關鍵字

病人安全 ； 社會控制 ； 醫療失誤事件 ； 醫療改革

並列摘要

Since the release of ”To Err Is Human”, the Institute of Medicine has created patient safety as the slogan of the reform of the health care medical system. As the Institute of Medicine has successfully used several horrible medical adverse events to make the public be aware of the importance of patient safety, for the issue is so close to most people and so devastating while the medical adverse events were occurring, thus the Institute of Medicine arouses the people to identify the significance of the patient safety, and in this way, we could say the Institute of Medicine is quite successful and impressive in manipulating this topic. The Institute of Medicine was charged to unveil the reform of the health care medical system by the federal government for the promotion of the quality for the next ten years. From then on, not only the United States, but also the European countries, and the Australia all started to implement measures or policies to improve patient safety culture for better health care quality. Patient safety is a part of the reform of health care medical system for the promotion of the quality, yet from the other perspective of sociology and medical history, this kind of the reform of patient safety is also a form of ”social control” from outer side, this sort of social control is for the standardization and titration of the delivery of health care. In the United States, the accreditation system like the Joint Commission Accreditation of Healthcare Organization (JCAHO, now named as Joint Commission) can accredit the healthcare organization such as the hospitals, nursing home, and other medical systems to influence the reimbursement of the medical organizations, and it means the absolute compliance of the medical organization for the accrediting rules, and this implementation of the accreditation could be used as a way to cut the growing budget of the medical expenses, and the regulation rules also build the bureaucratic system more unbreakable. In the meantime, we could see the loss caused by the imperfect quality of healthcare delivery, such as the individual level and macroscopic level loss, even the loss of gross national productivity was mentioned. Thus, the medical systems are not saviors any more; they're the blamed targets by the public. We are going to introduce the broad spectrum of patient safety in a concise category for the medical system and wish the practitioners to understand this so-called ”century tsunami” could drown anyone not well prepared and we will discuss this impact imposed by patient safety culture from the perspective of sociology and medical history.

並列關鍵字

Patient safety ； Social control ； Medical adverse events ； Medical reform