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

【摘要】："Open disclosure"即公開披露機制,是指公開探討導(dǎo)致患者在醫(yī)療衛(wèi)生保健服務(wù)中遭受損害的事件,用表達遺憾和誠摯的歉意來安撫患者及其支持者的情緒并彌補其損失的處理醫(yī)療異常事件、避免醫(yī)療糾紛,緩解醫(yī)患矛盾的一種機制。該機制是一種信息傳遞機制,主要針對的是患者及其支持者。該機制具有道德性,不僅是事后處理機制,同時也是預(yù)防機制。公開披露機制的意義起初僅僅是醫(yī)療機構(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知。公開披露機制以“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“溝通的開放性與及時性原則,自認、承認原則,表達遺憾原則,認同患者及其支持者的合理期望原則,員工支持原則,整合風險管理的系統(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,誠實信用原則應(yīng)當作為公開披露機制原則中的最高準則。公開披露機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。在公開披露中,各當事人都應(yīng)當遵守公開披露原則,履行自己應(yīng)盡的“權(quán)利義務(wù)”。公開披露的主要程序有：事件的發(fā)現(xiàn)與評估、事件的回應(yīng)、召開公開披露會議、事件的調(diào)查與追蹤討論、完成程序、相關(guān)單位的通報。醫(yī)療機構(gòu)可以根據(jù)實際情況,決定公開披露程序的進行程度,以節(jié)省資源。在公開披露機制理論研究日臻成熟的同時,澳大利亞也對公開披露機制通過深度訪談和調(diào)查問卷的形式對其實證價值進行了研究。實證研究表明：醫(yī)事人員實施公開披露機制的能力、醫(yī)療機構(gòu)及醫(yī)事人員對名譽和法律的恐懼以及醫(yī)療機構(gòu)的組織能力及外部的一些配套措施方面有可能對公開披露機制實施造成阻礙。因此,需要在內(nèi)部培養(yǎng)和訓練醫(yī)事人員的溝通能力,強化醫(yī)療機構(gòu)的組織能力；在外部建立成熟的保險機制,道歉法、病人安全法等法律保障公開披露機制的實施。我國在處理醫(yī)療異常事件,應(yīng)當借鑒公開披露機制。重視患者及其支持者參與來探討醫(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)建以公開披露為第一道醫(yī)療糾紛ADR解決機制。鑒于我國的國情和實際情況,在構(gòu)建完整的公開披露機制時,應(yīng)當采取“由上到下”的路徑,借鑒國外先進的研究成果,結(jié)合我國現(xiàn)有的法律政策并完善相關(guān)制度以確保公開披露機制更好的實施。
[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.
【學位授予單位】：北京化工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：D923

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