医疗纠纷控制研究
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摘要
研究目的
以过程方式或谓过程导向从事质量管理是ISO 9000:2000年版质量管理系统最为强调的一部份,因为既然“凡事均在过程中完成”过程管理便应在管理中予以定调,将它列为管理原则之一。对于医疗纠纷的控制也当然应该强调以过程方式进行。
本研究一方面旨在通过文献归纳法和Delphi法、创新性地区分医疗纠纷预兆和内因,首次研制和验证医疗纠纷预兆诊断量表,从而为评价和诊断医疗机构的医疗纠纷发生危险程度提供工具,作为医疗纠纷控制研究之事前控制的重要手段;另外一方面旨在通过调查和分析医疗纠纷发生后,医患双方(主要是患方)如何衡量或运用各种纠纷处理途径及其相关情况,评价和分析不同处理途径,探索医疗纠纷处理的新的制度安排,作为医疗纠纷控制研究之事后控制的重要途径。结合以上两方面达到医疗纠纷控制的目的,为我国医疗纠纷管理提供实用工具和理论基础。
研究方法
本研究采用了文献检索法、Delphi法、现场调查法、描述性分析法、理论分析法对医疗纠纷控制进行研究。在数据资料分析和数据处理中,运用了χ2检验、t检验、简单综合评价进行统计学处理,在理论分析部分,借鉴了经济学尤其是法律的经济分析方法对纠纷处理途径进行分析推理。
研究内容
本研究在医疗纠纷控制研究之事前控制,即医疗纠纷预兆诊断量表研制中,其内容包括:1.预兆提炼形成医疗纠纷预兆诊断量表草案;2.专家咨询,修改形成医疗纠纷预兆诊断量表;3.建立医疗纠纷预兆与内因因果关系调查问卷;4.量表使用,形成医院医疗纠纷预兆分布图,判断医院对于医疗纠纷预兆预防程度并提出建议。在医疗纠纷控制研究之事后控制,即医疗纠纷处理途径研究中,其内容包括:1.探讨173个医疗纠纷处理案例,包括纠纷处理途径整体情况、医患双方纠纷处理主观指标、不同处理途径客观情况等等;2.以法律的经济分析方法为主要工具,结合调查数据分析比较不同医疗纠纷处理途径,做到描述现况、分析原因、解释现象;3.提出优化医疗纠纷处理制度安排策略。
研究结果
研究表明,首次研制的医疗纠纷预兆诊断量表具有一定的实用价值,通过区分预兆和内因的方式对于评价医疗纠纷预防程度、挖掘医疗纠纷发生的深层次原因、提高医疗纠纷危机管理和降低医疗纠纷发生程度具有积极意义,能够起到医疗纠纷事前控制的作用。量表通过逻辑分析具有较好的效度,量表整体克朗巴哈a信度系数为0.92。纠纷处理研究表明,客观方面为医疗纠纷处理多为协商,调解和诉讼较少。究其原因一方面在于协商符合我国的传统法律文化,另一方面协商经济迅速,处理效率更高,处理周期最短为47天,患方平均费用为257元;相反调解缺乏中立性,对患方没有吸引力,并且成本也不低,调解处理周期为242天,患方平均费用为4833元;诉讼途径成本高昂,医患双方得不偿失,诉讼处理周期为511天,患方平均费用为20735元;调解途径更易出现医闹现象,并且患方选择医闹行动也内含着一种经济逻辑。主观方面表现为医患双方在适用法律观点、鉴定机构选择、不同处理途径满意状况以及胜诉预期等方面存在差异,这些因素对纠纷处理途径的选择存在影响。总之,结合现行法律和法社会学理论,从经济分析的角度来解释、评价和分析医疗纠纷处理的现况,不难发现目前医疗纠纷处理途径安排社会成本过高,应该综合优化不同处理途径、建立多元纠纷处理机制,朝着降低纠纷处理成本的方向发展。
研究创新
本研究首次建立和使用了医疗纠纷预兆诊断量表,创新性地提出了区分预兆和内因,形成了医疗纠纷预兆与内因关系调查问卷,探索了预兆和内因的定量联系。理论研究部分也率先将法社会学和法经济学的新成果运用到卫生法律的研究中来。
Research Purpose
To inspect the quality by the ways or the guidance of process is the core of the quality management system of ISO: 2000. Everything is finished during the process, so the process management should be attached to much importance and looked upon as one of the basic principles. This is the case in the management of medical disputes.
By inducing the literature and Delphi, the thesis sets up and validates the standard on the signs of medical disputes to work as a tool of predicting the probability of the medical disputes, then to some extent medical disputes could be held back. On the other hand, the thesis establishes a new system to deal with the medical disputes as a remediation by research on its settling ways, the corresponding result and the relating situations. In this way, the practical tools and theoretical basis for the management of medical disputes in China are established.
Research Methods
Inducing the literature, Delphi, survey on the spot, descriptive analyses and theoretical analyses are adopted in research on the management of medical tangle.χ2 test , t test and simple comprehensive analyses are adopted to deal with the statistics In the data processing ,the economic analysis, especially the legal economic analysis is conducted in theoretical analysis.
Contents
In the process of research on the beforehand management of medical disputes, that is to say, to set up and validate the standard on the signs, the main contents include: the draft of the standard on the signs of medical disputes; the standard on the signs of medical disputes after the consult on expert and the revision; the establishment of the questionnaire on the causal relation between medical disputes and the internal cause; the real diagnosis meter, forms the hospital medical service dispute omen distribution map, judges the hospital and puts forward the proposal regarding the medical dispute omen prevention degree. In the process of research the afterward management of medical tangles, that is to say, to research on the process of the dealing of management of medical disputes, the main contents include: to discusses 173 cases on the dealing of management of medical disputes, including the overall situation, the subjective target of both sides in disputes processes, different situation route in different process and so on; to take the legal economic analysis method as the main vehicle, on the basis of the data to analyze and compare quite different ways of the management of medical disputes, by decrypting the phenomenon, analyzing the reason, the explaining the phenomenon; to proposed the institutional arrangements strategy that improve the management of medical disputes.
Results
The research indicated that the standard on the signs of medical disputes has certain practical value,and it is of much significance to value the extent to prevent the medical disputes, to probe into the root cause, to improve the management and to reduce the probability of the medical disputes by differing the signs and the inner causes, which can prevent the medical disputes beforehand; Cronbach’s alpha coefficient of the standard is 0.92,it was showed that the reliability of the indicators is very good. The research simultaneously also indicated that the settling ways of medical disputes are consultation but not the mediation or the lawsuit mainly. Then what are the reasons? On the one hand, consultation conforms to our country's traditional law culture; on the other hand consultation is economic, rapid, and more efficient. Its settling time is 47 days , and take patient’s 257 yuan; On the contrary, the mediation lacks the neutrality, and does not have the attraction to the patient party, Its settling time is 242 days , and take patient’s 4833 yuan; the cost of lawsuit is too high, Its settling time is 511 days , and take patient’s 20735 yuan. so what both parties gain does not equal what they lose. Consultation is more likely to cause“medical dispute profiteer”phenomenon, and that the patient party chose the motion called“the medical dispute profiteer”is economical logic; the anticipation of winning the lawsuit has influence on the choice of the settling ways of medical disputes. In brief,The cost of the present settling ways of medical disputes was excessively high, and it should be reduced by the establishment of multi-dimensional dispute-settling ways.
Innovations
In the research, the author establishes and utilizes the medical dispute omen diagnosis meter for the first time, innovatively proposes the discrimination of omen and the internal cause, and has formed the medical dispute omen and the internal cause relations questionnaire, has explored the quota relation between the omen and the internal cause. In the theoretical research part the author take the new achievement of sociological law and the economic analysis of law into the hygienic law.
以过程方式或谓过程导向从事质量管理是ISO 9000:2000年版质量管理系统最为强调的一部份,因为既然“凡事均在过程中完成”过程管理便应在管理中予以定调,将它列为管理原则之一。对于医疗纠纷的控制也当然应该强调以过程方式进行。
本研究一方面旨在通过文献归纳法和Delphi法、创新性地区分医疗纠纷预兆和内因,首次研制和验证医疗纠纷预兆诊断量表,从而为评价和诊断医疗机构的医疗纠纷发生危险程度提供工具,作为医疗纠纷控制研究之事前控制的重要手段;另外一方面旨在通过调查和分析医疗纠纷发生后,医患双方(主要是患方)如何衡量或运用各种纠纷处理途径及其相关情况,评价和分析不同处理途径,探索医疗纠纷处理的新的制度安排,作为医疗纠纷控制研究之事后控制的重要途径。结合以上两方面达到医疗纠纷控制的目的,为我国医疗纠纷管理提供实用工具和理论基础。
研究方法
本研究采用了文献检索法、Delphi法、现场调查法、描述性分析法、理论分析法对医疗纠纷控制进行研究。在数据资料分析和数据处理中,运用了χ2检验、t检验、简单综合评价进行统计学处理,在理论分析部分,借鉴了经济学尤其是法律的经济分析方法对纠纷处理途径进行分析推理。
研究内容
本研究在医疗纠纷控制研究之事前控制,即医疗纠纷预兆诊断量表研制中,其内容包括:1.预兆提炼形成医疗纠纷预兆诊断量表草案;2.专家咨询,修改形成医疗纠纷预兆诊断量表;3.建立医疗纠纷预兆与内因因果关系调查问卷;4.量表使用,形成医院医疗纠纷预兆分布图,判断医院对于医疗纠纷预兆预防程度并提出建议。在医疗纠纷控制研究之事后控制,即医疗纠纷处理途径研究中,其内容包括:1.探讨173个医疗纠纷处理案例,包括纠纷处理途径整体情况、医患双方纠纷处理主观指标、不同处理途径客观情况等等;2.以法律的经济分析方法为主要工具,结合调查数据分析比较不同医疗纠纷处理途径,做到描述现况、分析原因、解释现象;3.提出优化医疗纠纷处理制度安排策略。
研究结果
研究表明,首次研制的医疗纠纷预兆诊断量表具有一定的实用价值,通过区分预兆和内因的方式对于评价医疗纠纷预防程度、挖掘医疗纠纷发生的深层次原因、提高医疗纠纷危机管理和降低医疗纠纷发生程度具有积极意义,能够起到医疗纠纷事前控制的作用。量表通过逻辑分析具有较好的效度,量表整体克朗巴哈a信度系数为0.92。纠纷处理研究表明,客观方面为医疗纠纷处理多为协商,调解和诉讼较少。究其原因一方面在于协商符合我国的传统法律文化,另一方面协商经济迅速,处理效率更高,处理周期最短为47天,患方平均费用为257元;相反调解缺乏中立性,对患方没有吸引力,并且成本也不低,调解处理周期为242天,患方平均费用为4833元;诉讼途径成本高昂,医患双方得不偿失,诉讼处理周期为511天,患方平均费用为20735元;调解途径更易出现医闹现象,并且患方选择医闹行动也内含着一种经济逻辑。主观方面表现为医患双方在适用法律观点、鉴定机构选择、不同处理途径满意状况以及胜诉预期等方面存在差异,这些因素对纠纷处理途径的选择存在影响。总之,结合现行法律和法社会学理论,从经济分析的角度来解释、评价和分析医疗纠纷处理的现况,不难发现目前医疗纠纷处理途径安排社会成本过高,应该综合优化不同处理途径、建立多元纠纷处理机制,朝着降低纠纷处理成本的方向发展。
研究创新
本研究首次建立和使用了医疗纠纷预兆诊断量表,创新性地提出了区分预兆和内因,形成了医疗纠纷预兆与内因关系调查问卷,探索了预兆和内因的定量联系。理论研究部分也率先将法社会学和法经济学的新成果运用到卫生法律的研究中来。
Research Purpose
To inspect the quality by the ways or the guidance of process is the core of the quality management system of ISO: 2000. Everything is finished during the process, so the process management should be attached to much importance and looked upon as one of the basic principles. This is the case in the management of medical disputes.
By inducing the literature and Delphi, the thesis sets up and validates the standard on the signs of medical disputes to work as a tool of predicting the probability of the medical disputes, then to some extent medical disputes could be held back. On the other hand, the thesis establishes a new system to deal with the medical disputes as a remediation by research on its settling ways, the corresponding result and the relating situations. In this way, the practical tools and theoretical basis for the management of medical disputes in China are established.
Research Methods
Inducing the literature, Delphi, survey on the spot, descriptive analyses and theoretical analyses are adopted in research on the management of medical tangle.χ2 test , t test and simple comprehensive analyses are adopted to deal with the statistics In the data processing ,the economic analysis, especially the legal economic analysis is conducted in theoretical analysis.
Contents
In the process of research on the beforehand management of medical disputes, that is to say, to set up and validate the standard on the signs, the main contents include: the draft of the standard on the signs of medical disputes; the standard on the signs of medical disputes after the consult on expert and the revision; the establishment of the questionnaire on the causal relation between medical disputes and the internal cause; the real diagnosis meter, forms the hospital medical service dispute omen distribution map, judges the hospital and puts forward the proposal regarding the medical dispute omen prevention degree. In the process of research the afterward management of medical tangles, that is to say, to research on the process of the dealing of management of medical disputes, the main contents include: to discusses 173 cases on the dealing of management of medical disputes, including the overall situation, the subjective target of both sides in disputes processes, different situation route in different process and so on; to take the legal economic analysis method as the main vehicle, on the basis of the data to analyze and compare quite different ways of the management of medical disputes, by decrypting the phenomenon, analyzing the reason, the explaining the phenomenon; to proposed the institutional arrangements strategy that improve the management of medical disputes.
Results
The research indicated that the standard on the signs of medical disputes has certain practical value,and it is of much significance to value the extent to prevent the medical disputes, to probe into the root cause, to improve the management and to reduce the probability of the medical disputes by differing the signs and the inner causes, which can prevent the medical disputes beforehand; Cronbach’s alpha coefficient of the standard is 0.92,it was showed that the reliability of the indicators is very good. The research simultaneously also indicated that the settling ways of medical disputes are consultation but not the mediation or the lawsuit mainly. Then what are the reasons? On the one hand, consultation conforms to our country's traditional law culture; on the other hand consultation is economic, rapid, and more efficient. Its settling time is 47 days , and take patient’s 257 yuan; On the contrary, the mediation lacks the neutrality, and does not have the attraction to the patient party, Its settling time is 242 days , and take patient’s 4833 yuan; the cost of lawsuit is too high, Its settling time is 511 days , and take patient’s 20735 yuan. so what both parties gain does not equal what they lose. Consultation is more likely to cause“medical dispute profiteer”phenomenon, and that the patient party chose the motion called“the medical dispute profiteer”is economical logic; the anticipation of winning the lawsuit has influence on the choice of the settling ways of medical disputes. In brief,The cost of the present settling ways of medical disputes was excessively high, and it should be reduced by the establishment of multi-dimensional dispute-settling ways.
Innovations
In the research, the author establishes and utilizes the medical dispute omen diagnosis meter for the first time, innovatively proposes the discrimination of omen and the internal cause, and has formed the medical dispute omen and the internal cause relations questionnaire, has explored the quota relation between the omen and the internal cause. In the theoretical research part the author take the new achievement of sociological law and the economic analysis of law into the hygienic law.
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