医疗异常事件处理中的公开披露机制研究

发布时间：2018-06-11 12:55

本文选题：医疗异常事件 + 公开披露　；参考：《北京化工大学》2015年硕士论文

【摘要】："Open disclosure"即公开披露机制,是指公开探讨导致患者在医疗卫生保健服务中遭受损害的事件,用表达遗憾和诚挚的歉意来安抚患者及其支持者的情绪并弥补其损失的处理医疗异常事件、避免医疗纠纷,缓解医患矛盾的一种机制。该机制是一种信息传递机制,主要针对的是患者及其支持者。该机制具有道德性,不仅是事后处理机制,同时也是预防机制。公开披露机制的意义起初仅仅是医疗机构为了节省诉讼成本,而如今的减少医疗损害诉讼、提供患者及其支持者介入医疗异常事件处理氛围、以患者安全为中心、缓解医患矛盾等多元化意义逐渐被人们所认知。公开披露机制以“重视沟通”“尊重患者”“以患者安全为中心”“衡平医患双方利益”为一般原则,以“沟通的开放性与及时性原则,自认、承认原则,表达遗憾原则,认同患者及其支持者的合理期望原则,员工支持原则,整合风险管理的系统改善原则,善良管理原则,保密原则”等原则为具体原则。除此之外,诚实信用原则应当作为公开披露机制原则中的最高准则。公开披露机制适用的范围主要是因医行为引起的医疗损害事件和因医疗产品或医疗机构安全保障义务等引起的其他医疗不良事件。在公开披露中,各当事人都应当遵守公开披露原则,履行自己应尽的“权利义务”。公开披露的主要程序有：事件的发现与评估、事件的回应、召开公开披露会议、事件的调查与追踪讨论、完成程序、相关单位的通报。医疗机构可以根据实际情况,决定公开披露程序的进行程度,以节省资源。在公开披露机制理论研究日臻成熟的同时,澳大利亚也对公开披露机制通过深度访谈和调查问卷的形式对其实证价值进行了研究。实证研究表明：医事人员实施公开披露机制的能力、医疗机构及医事人员对名誉和法律的恐惧以及医疗机构的组织能力及外部的一些配套措施方面有可能对公开披露机制实施造成阻碍。因此,需要在内部培养和训练医事人员的沟通能力,强化医疗机构的组织能力；在外部建立成熟的保险机制,道歉法、病人安全法等法律保障公开披露机制的实施。我国在处理医疗异常事件,应当借鉴公开披露机制。重视患者及其支持者参与来探讨医疗异常事件、充分保证患者及其支持者的知情权、提供必要的支持,保证患者及其支持者参与医疗异常事件的探讨、充分尊重患者及其支持者,以患者安全为中心。并努力尝试构建以公开披露为第一道医疗纠纷ADR解决机制。鉴于我国的国情和实际情况,在构建完整的公开披露机制时,应当采取“由上到下”的路径,借鉴国外先进的研究成果,结合我国现有的法律政策并完善相关制度以确保公开披露机制更好的实施。
[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.
【学位授予单位】：北京化工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：D923

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