本文選題：醫(yī)療異常事件 + 公開(kāi)披露　； 參考：《北京化工大學(xué)》2015年碩士論文

【摘要】："Open disclosure"即公開(kāi)披露機(jī)制,是指公開(kāi)探討導(dǎo)致患者在醫(yī)療衛(wèi)生保健服務(wù)中遭受損害的事件,用表達(dá)遺憾和誠(chéng)摯的歉意來(lái)安撫患者及其支持者的情緒并彌補(bǔ)其損失的處理醫(yī)療異常事件、避免醫(yī)療糾紛,緩解醫(yī)患矛盾的一種機(jī)制。該機(jī)制是一種信息傳遞機(jī)制,主要針對(duì)的是患者及其支持者。該機(jī)制具有道德性,不僅是事后處理機(jī)制,同時(shí)也是預(yù)防機(jī)制。公開(kāi)披露機(jī)制的意義起初僅僅是醫(yī)療機(jī)構(gòu)為了節(jié)省訴訟成本,而如今的減少醫(yī)療損害訴訟、提供患者及其支持者介入醫(yī)療異常事件處理氛圍、以患者安全為中心、緩解醫(yī)患矛盾等多元化意義逐漸被人們所認(rèn)知。公開(kāi)披露機(jī)制以“重視溝通”“尊重患者”“以患者安全為中心”“衡平醫(yī)患雙方利益”為一般原則,以“溝通的開(kāi)放性與及時(shí)性原則,自認(rèn)、承認(rèn)原則,表達(dá)遺憾原則,認(rèn)同患者及其支持者的合理期望原則,員工支持原則,整合風(fēng)險(xiǎn)管理的系統(tǒng)改善原則,善良管理原則,保密原則”等原則為具體原則。除此之外,誠(chéng)實(shí)信用原則應(yīng)當(dāng)作為公開(kāi)披露機(jī)制原則中的最高準(zhǔn)則。公開(kāi)披露機(jī)制適用的范圍主要是因醫(yī)行為引起的醫(yī)療損害事件和因醫(yī)療產(chǎn)品或醫(yī)療機(jī)構(gòu)安全保障義務(wù)等引起的其他醫(yī)療不良事件。在公開(kāi)披露中,各當(dāng)事人都應(yīng)當(dāng)遵守公開(kāi)披露原則,履行自己應(yīng)盡的“權(quán)利義務(wù)”。公開(kāi)披露的主要程序有：事件的發(fā)現(xiàn)與評(píng)估、事件的回應(yīng)、召開(kāi)公開(kāi)披露會(huì)議、事件的調(diào)查與追蹤討論、完成程序、相關(guān)單位的通報(bào)。醫(yī)療機(jī)構(gòu)可以根據(jù)實(shí)際情況,決定公開(kāi)披露程序的進(jìn)行程度,以節(jié)省資源。在公開(kāi)披露機(jī)制理論研究日臻成熟的同時(shí),澳大利亞也對(duì)公開(kāi)披露機(jī)制通過(guò)深度訪談和調(diào)查問(wèn)卷的形式對(duì)其實(shí)證價(jià)值進(jìn)行了研究。實(shí)證研究表明：醫(yī)事人員實(shí)施公開(kāi)披露機(jī)制的能力、醫(yī)療機(jī)構(gòu)及醫(yī)事人員對(duì)名譽(yù)和法律的恐懼以及醫(yī)療機(jī)構(gòu)的組織能力及外部的一些配套措施方面有可能對(duì)公開(kāi)披露機(jī)制實(shí)施造成阻礙。因此,需要在內(nèi)部培養(yǎng)和訓(xùn)練醫(yī)事人員的溝通能力,強(qiáng)化醫(yī)療機(jī)構(gòu)的組織能力；在外部建立成熟的保險(xiǎn)機(jī)制,道歉法、病人安全法等法律保障公開(kāi)披露機(jī)制的實(shí)施。我國(guó)在處理醫(yī)療異常事件,應(yīng)當(dāng)借鑒公開(kāi)披露機(jī)制。重視患者及其支持者參與來(lái)探討醫(yī)療異常事件、充分保證患者及其支持者的知情權(quán)、提供必要的支持,保證患者及其支持者參與醫(yī)療異常事件的探討、充分尊重患者及其支持者,以患者安全為中心。并努力嘗試構(gòu)建以公開(kāi)披露為第一道醫(yī)療糾紛ADR解決機(jī)制。鑒于我國(guó)的國(guó)情和實(shí)際情況,在構(gòu)建完整的公開(kāi)披露機(jī)制時(shí),應(yīng)當(dāng)采取“由上到下”的路徑,借鑒國(guó)外先進(jìn)的研究成果,結(jié)合我國(guó)現(xiàn)有的法律政策并完善相關(guān)制度以確保公開(kāi)披露機(jī)制更好的實(shí)施。
[Abstract]:"Open disclosure", the public disclosure mechanism, refers to an open discussion of events that result in patients being harmed in health care services, It is a mechanism to appease patients and their supporters by expressing regret and sincere apology to deal with medical anomalies, avoid medical disputes and ease the conflicts between doctors and patients. This mechanism is a kind of information transmission mechanism, mainly aimed at patients and their supporters. The mechanism is moral, not only after the treatment mechanism, but also as a preventive mechanism. The purpose of the public disclosure mechanism was initially to reduce litigation costs for medical institutions, but now to reduce medical damage lawsuits, provide an atmosphere in which patients and their supporters intervene in medical anomalies, and focus on patient safety. The pluralistic significance of relieving the contradiction between doctors and patients is gradually recognized by people. The mechanism of public disclosure takes "paying attention to communication", "respecting patients", "taking patient safety as the center," balancing the interests of both doctors and patients "as the general principle, and" the principles of openness and timeliness of communication, self-recognition, recognition and expression of regret ", The principle of reasonable expectation of patients and their supporters, the principle of staff support, the principle of systematic improvement of integrated risk management, the principle of good management and the principle of confidentiality are the specific principles. In addition, the principle of good faith should be regarded as the highest criterion in the principle of public disclosure mechanism. The scope of application of the public disclosure mechanism is mainly medical injury events caused by medical behavior and other medical adverse events caused by medical products or medical institutions' safety and security obligations. In public disclosure, all parties should abide by the principle of public disclosure and fulfill their rights and obligations. The main procedures of public disclosure are: the discovery and evaluation of events, the response of events, the convening of public disclosure meetings, the investigation and follow-up discussion of incidents, the completion of procedures, and the notification of relevant units. Medical institutions may, according to the actual situation, determine the extent to which the public disclosure process is carried out in order to save resources. While the theory of public disclosure mechanism is becoming more and more mature, Australia also studies the empirical value of public disclosure mechanism through in-depth interviews and questionnaires. Empirical research shows that the ability of medical personnel to implement the public disclosure mechanism, The fear of reputation and law among medical institutions and medical staff, as well as the organizational capacity of medical institutions and some complementary external measures, may hinder the implementation of public disclosure mechanisms. Therefore, it is necessary to cultivate and train the communication ability of medical personnel internally, strengthen the organization ability of medical institutions, and establish mature insurance mechanism, apology law, patient safety law and other laws to ensure the implementation of public disclosure mechanism. In dealing with medical anomalies, our country should draw lessons from the public disclosure mechanism. Pay attention to the participation of patients and their supporters to discuss medical abnormal events, fully guarantee the right of patients and their supporters to know, provide necessary support, and ensure that patients and their supporters participate in the discussion of medical abnormal events. Fully respect patients and their supporters and focus on patient safety. And try hard to construct the ADR resolution mechanism of public disclosure as the first medical dispute. In view of our country's national conditions and actual conditions, when constructing a complete public disclosure mechanism, we should take a "top-down" approach and learn from the advanced research results of foreign countries. In order to ensure the better implementation of the public disclosure mechanism, we should combine the existing laws and policies of our country and perfect the relevant system.
【學(xué)位授予單位】：北京化工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：D923

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