中国医院医疗安全管理的策略研究
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摘要
目的:当前中国医疗改革方向尚未明了,许多医院正处在等待张望状况,虽然有一部分医院已经进行了一系列医院内部医疗安全管理的改革与大胆尝试,但由于没有一系列医疗安全管理理论的支持和研究成果的借鉴,我国医院医疗纠纷和医患矛盾的严峻局面仍然得不到有效的控制和改善,导致许多医院管理者无所适从、徘徊迷茫。究其原因,与当前的整个医疗大环境有关,同时也与医疗安全管理理论研究的缺陷有关。当前,日本等一些国家的专家提出了医疗安全管理的理念和实施建议,美国、英国、澳大利亚、日本等国借鉴了航空安全管理经验之后进行了初步的尝试,取得了比较好的效果。在我国,随着全球一体化进程的快速推进,医学研究得到了飞速的发展,医疗药械的不断涌现,新诊疗技术的日新月异,给许多病人带来了信心和希望,同时,也潜伏着许多不安全的隐患和管理盲点,特别是新的医疗事故处理条例出台之后,给医疗安全管理敲响了警钟,已成为全社会关注的焦点之一。如何系统地进行医疗安全管理理论的研究与创新,如何切实有效地转变医疗安全管理的理念,控制医疗缺陷和医疗事故的发生,适应新形势下不断变化的医疗市场,为我国政府部门和卫生行政管理部门以及医院管理者提供理论依据和策略建议,是本研究的目的和关键。
方法:1.文献法:广泛收集国内外医院医疗安全管理相关的文献、资料、数据,包括航空安全管理、医疗安全管理以及系统管理理论、权变管理理论等相关的理论和方法,并采用文献资料分析优选法、内容分析、meta分析等方法进行深入分析,为界定医院医疗安全管理体系概念、制定全面医疗安全管理核心要素、识别医疗安全预警体系及其评价体系等关键问题、探究问题成因提供理论支持。2.德尔菲法:通过对有关专家进行信函调查,通过信函邮寄的方式,就医院医疗安全的外部环境因素、医院内部系统管理方面的危险因素、全面医疗安全管理核心要素、医疗安全预警体系及其评价体系进行两轮咨询,结合层次分析法确立核心要素以及指标评价体系。3、现场调查方法:本次研究的调研地区与调研对象的选择以经济水平和地理位置作为分层抽样的依据,在我国东、中、西部地区分别抽取了10、9、8个省份作为调查地区,每个省份根据省级城市和县市级城市采取系统抽样的方法分别选择三级医院和二级医院,进行调研并收集相关信息与数据资料。共计调查27个省,103家医院。资料收集方法:包括医院状况问卷调查、专题小组讨论(Focus group discussion)、专家咨询等。4、分析方法:本研究采用定性、定量分析方法,其中定性方法包括描述性分析法、层次分析法(AHP)、因果分析图法、模糊综合评判(Fuzzy ComprehensiveEvaluation,简称FCE)、运用多元回归分析法等。5、质量控制:识别误差来源,并予以控制,保证结论的可靠性。
结论:(1)医院领导者在短期内对医院运行、业务收入、医疗纠纷增长率等影响不大,似乎目前医院管理者还未能找到导致医院医疗纠纷增长的主要原因。由于医院特别是大型医院一般都具有悠久的历史,已经形成自己特有的医院文化,即使医院领导者短期内没能发挥影响,医院也会正常运行下去,这与企业截然不同。(2)当前医院领导者对确保医疗安全的内部因素及解决医疗隐患的看法上,更多地注重医护人员的个人技术准入和医务界内部解决,对医疗差错发生根源的看法绝大部分还局限在医院内部管理和对内部员工的抱怨,说明许多医院领导者仍然未意识到医疗安全隐患的根源是出在医院系统而非个人,所采取的解决措施都是针对医护人员或医院内部系统,但收效甚微,说明绝大多数医院的领导者在实践工作中仍然缺乏权变管理,这些医院领导者还是囿于医院内部解决,未能跳出医院的范围到外界查找原因。(3)极少有医院领导者认为要向其他行业学习。现行医院领导者大多为专家管理型,不善于向其他高风险行业学习,无法通过学习使自身成为高可靠性组织,况且目前中国医院的运行模式与企业运行模式相差甚远,职业管理者也难以在医院管理中发挥更大的作用,使得目前中国医院管理处于两难境界。(4)政府决策层态度的模棱两可或迟疑不决往往造成医院管理者无所适从并助长了老百姓对医院的不满,政府若不有意识地引导和降低病人对医院过高的期望值,医疗投诉和医疗纠纷必然会持续不断,医疗安全将无法保障。
创新与建议:创新与建议:(1)本研究通过调查问卷发现:医疗纠纷的发生率呈现不同程度的攀升;医院管理者还未能找到导致医院医疗纠纷增长的主要原因;绝大多数医院的领导者满足于医院内部系统的改造与管理,缺乏权变理念,不善于从医院环境之外去寻找解决医疗纠纷的途径;极少有医院领导者认为要向其他行业学习。商业航空业所实行的航空安全报告系统、航空风险分析系统、灾害预警指标体系、航空安全文化的创建等是提升航空安全可靠性的重要因素,为医疗安全管理提供了借鉴的模式。
(2)本研究通过对医疗安全管理新理念的剖析以及对系统管理理论和权变管理理论的探讨,建议医院主要领导者除了要对医院内部系统进行管理和改造之外,更重要的是要积极向其他行业学习,应用权变管理理论,对医院外部环境进行评估,随机应变,做出适合自己医院发展的战略决策,引导全体员工大刀阔斧地向前发展。在当前医疗安全形势非常严峻以及医疗改革不明了的情况下,固守张望或迟疑不决的领导者只会将医院引向退却甚至绝路,应引以为戒。
(3)本研究首次提出了全面医疗安全管理的概念和全面医疗安全管理的核心元素、组织构架及其功能,强调政府、医疗行业及全社会共同关心和支持医疗安全管理。总结出了实施全面医疗安全管理的具体措施:全面质量管理、医院医疗安全报告系统、医院重大医疗风险预警指标体系、医院医疗安全管理效果评价体系和创建医院安全文化等,实行从卫生部到基层医院的全国医疗安全一体化管理及反馈制度,见微知著,防微杜渐,共同创建和谐的医患关系,走出一条具有中国特色的医疗安全管理路子,探索并制定出有利于医患安全并切实可行的中国医疗安全管理体系。
Objective: At present, China still do not understand the direction of health care reform, and many hospitals are in waiting for the situation around, although there is a part of the hospital having carried out a series of hospital in-house medical safety management reform and boldly try them, however, because of the lack of the support of a series of medical safety management theory and the recommendation of the research results, our hospital has encountered a critical situation of medical disputes between doctors and patients which was still not controlled and improved effectively, and resulted in a number of hospital administrators confused and lingered. The reason was related to the current health care environment, as well as the defect in medical and safety management theory research. At present, some of the experts in Japan and other countries are putting forward the idea of medical safety management and its implementation, and the United States, Britain, Australia, Japan and other countries learned from the experience and management of aviation safety and afterwards they have made a preliminary attempt and have obtained a better effect. In our country, with the rapid development of the global integration process, medical research has been in the rapid development that medical instruments has emerged, and new treating skills has been renewed with each passing day, thus bringing many patients with confidence and hope, while at the same time, many insecurity risks and blind spots in management are hid to bring a wake-up call to medical health safety management, particularly when the new regulations was introduced, which has become one of the social focuses. How to carry out medical research and theoretical innovation of the systematic medical safety management, how to effectively change the idea of medical safety management and control the happening of medical defects and incidents, and how to adapt to the new situation of ever-changing health care market in order to provide a theoretical basis and the proposed strategy for our government and health administration Management departments, as well as hospital managers, has formed the purpose and the key of this study.
Method: 1. Bibliography Method: to collect a wide range of medical safety management related bibliography, materials and data including the management of aviation safety, hospital medical safety management system, systematical management theory, contingency management theory, and other related theories and methods in and abroad, and to make in-depth analysis after adopting analytic methods of bibliography and data optimized analysis, content analysis, meta analysis, in order to provide theoretical support for exploring key issues and causes of defining the hospital medical safety management system concept, making the core elements of a comprehensive medical safety management, and identifying medical security early warning system and evaluating the system. 2、Delphi method: To investigate the relevant experts by letter. To make a 2-round consultation about the hospital medical safety external environment factors, internal system management risk factors, a comprehensive safety management core elements, and medical safety warning system and its evaluation system by mailed letters, combined with AHP to establish the core elements and the indicator evaluation system. 3、on-site survey method: the research region and object of the study is based at location and economic level as a stratified random basis, 10,9 or 8 provinces in China's eastern, central and western regions were taken as the investigation, and first-class hospitals and second-class hospitals were chose by systematic sampling methods in each provinces according to cities of provincial-level and city-level to carry out research and collect information and data. 27 provinces and 103 hospitals were total surveyed. Data collection methods: hospital situation survey, focus group discussion and expert consultation are included. 4、analytic method: qualitative analytic method and quantitative analytic method are adopted in this study, and qualitative analytic method includes analytic method of descriptive, AHP, cause and effect, FCE, multiple regression and so on. 5, quality control: to identify the source of error to be controlled so as to ensure the reliability of conclusions.
Conclusion: (1) president or vice president had little effects on growth of hospital operation, operating income and medical disputes in the near future, which seemed that the current hospital administrators still failed to find the main reason for growth in medical disputes of the hospital. As hospitals in particular the major hospitals generally has a long history, has formed its own unique culture of itself, even if the hospital leaders could not play the short term impact of the hospital, it will continue to operate, which is very different from enterprises. (2) both of president and vice president regard it important for the doctors and nurses individually and the internal system of the hospital which relates to the medical errors in hospitals, thus taking measures against the medical personnel or internal systems of the hospital, but few resulted, reflecting that the vast majority of hospital leaders lack of contingency management philosophy, who are not good at finding ways to resolve medical disputes outside the hospital environment. (3) there are very few presidents or vice presidents of hospitals are willing to learn from other industries. Most of the current leaders in the hospital taking it as granted as the management experts, so that they are not good at learning from other high-risk industries, and always keeping themselves unable to become a high-reliability organizations, and moreover, China's current hospital operation mode is very different form that of business, so professional managers can not play a greater role in hospital management, thus making China's current dilemma in the realm of hospital management. (4) The ambiguous or hesitated attitude of the government decision-makers often causes hospital managers at a loss and enhances people's dissatisfaction with the hospital, and the medical security will not be guaranteed with medical complaints and disputes inevitably continuing if the government does not consciously guide to reduce the patients' over-expectations about the hospital.
Innovation and recommendations: (1) This study found through a survey questionnaire that: the incidence of medical disputes has increased to varying degrees; hospital administrators still failed to find the main reason for growth in medical disputes of the hospital; the vast majority of hospital leaders lack of contingency management philosophy, who are not good at finding ways to resolve medical disputes outside the hospital environment; there are very few leaders of hospitals are willing to learn from other industries. The safety reporting system, aviation risk analysis systems, disaster early warning indicator system, aviation safety culture and so on adopted in the commercial aviation industry enhance the safety and reliability of aviation as an important factor, which provides a medical safety management with a reference model. (2) By the theory analysis of medical security and systems management and the theory of contingency management, this study proposed that leaders of the main hospitals should pay more importance to actively learning from other industries in addition to the management and transformation of the hospital internal system, apply contingency management theory to assess the hospital external environment and act responding to circumstances, so as to make strategic decisions fit for the development of their own hospitals to guide the staff boldly and resolutely forward. It should take warning from those tenaciously astound or hesitated leaders of hospital who will only lead the retreat and no return on current circumstances of very grim medical security situation and unclear healthcare reform. (3) This study proposed for the first time a total medical safety management concepts and total medical management of the core elements of security, organizational framework and its functions. This study summed up specific measures to implement total medical safety management: total quality management, hospital medical safety reporting system, hospital early warning indicator system of major medical risks, the hospital medical safety management performance evaluation system and the creation of a safety culture in hospitals, etc. The national medical security managing integration from the Health Ministry to the grassroot level hospitals and a feedback system are practiced to show a great significance and protection to promote to create a harmonious relationship between doctors and patients, hence walking in a medical safety management path with Chinese characteristics and exploring to fix the feasible China's practical medical safety management system beneficial to the security between doctors and patients.
方法:1.文献法:广泛收集国内外医院医疗安全管理相关的文献、资料、数据,包括航空安全管理、医疗安全管理以及系统管理理论、权变管理理论等相关的理论和方法,并采用文献资料分析优选法、内容分析、meta分析等方法进行深入分析,为界定医院医疗安全管理体系概念、制定全面医疗安全管理核心要素、识别医疗安全预警体系及其评价体系等关键问题、探究问题成因提供理论支持。2.德尔菲法:通过对有关专家进行信函调查,通过信函邮寄的方式,就医院医疗安全的外部环境因素、医院内部系统管理方面的危险因素、全面医疗安全管理核心要素、医疗安全预警体系及其评价体系进行两轮咨询,结合层次分析法确立核心要素以及指标评价体系。3、现场调查方法:本次研究的调研地区与调研对象的选择以经济水平和地理位置作为分层抽样的依据,在我国东、中、西部地区分别抽取了10、9、8个省份作为调查地区,每个省份根据省级城市和县市级城市采取系统抽样的方法分别选择三级医院和二级医院,进行调研并收集相关信息与数据资料。共计调查27个省,103家医院。资料收集方法:包括医院状况问卷调查、专题小组讨论(Focus group discussion)、专家咨询等。4、分析方法:本研究采用定性、定量分析方法,其中定性方法包括描述性分析法、层次分析法(AHP)、因果分析图法、模糊综合评判(Fuzzy ComprehensiveEvaluation,简称FCE)、运用多元回归分析法等。5、质量控制:识别误差来源,并予以控制,保证结论的可靠性。
结论:(1)医院领导者在短期内对医院运行、业务收入、医疗纠纷增长率等影响不大,似乎目前医院管理者还未能找到导致医院医疗纠纷增长的主要原因。由于医院特别是大型医院一般都具有悠久的历史,已经形成自己特有的医院文化,即使医院领导者短期内没能发挥影响,医院也会正常运行下去,这与企业截然不同。(2)当前医院领导者对确保医疗安全的内部因素及解决医疗隐患的看法上,更多地注重医护人员的个人技术准入和医务界内部解决,对医疗差错发生根源的看法绝大部分还局限在医院内部管理和对内部员工的抱怨,说明许多医院领导者仍然未意识到医疗安全隐患的根源是出在医院系统而非个人,所采取的解决措施都是针对医护人员或医院内部系统,但收效甚微,说明绝大多数医院的领导者在实践工作中仍然缺乏权变管理,这些医院领导者还是囿于医院内部解决,未能跳出医院的范围到外界查找原因。(3)极少有医院领导者认为要向其他行业学习。现行医院领导者大多为专家管理型,不善于向其他高风险行业学习,无法通过学习使自身成为高可靠性组织,况且目前中国医院的运行模式与企业运行模式相差甚远,职业管理者也难以在医院管理中发挥更大的作用,使得目前中国医院管理处于两难境界。(4)政府决策层态度的模棱两可或迟疑不决往往造成医院管理者无所适从并助长了老百姓对医院的不满,政府若不有意识地引导和降低病人对医院过高的期望值,医疗投诉和医疗纠纷必然会持续不断,医疗安全将无法保障。
创新与建议:创新与建议:(1)本研究通过调查问卷发现:医疗纠纷的发生率呈现不同程度的攀升;医院管理者还未能找到导致医院医疗纠纷增长的主要原因;绝大多数医院的领导者满足于医院内部系统的改造与管理,缺乏权变理念,不善于从医院环境之外去寻找解决医疗纠纷的途径;极少有医院领导者认为要向其他行业学习。商业航空业所实行的航空安全报告系统、航空风险分析系统、灾害预警指标体系、航空安全文化的创建等是提升航空安全可靠性的重要因素,为医疗安全管理提供了借鉴的模式。
(2)本研究通过对医疗安全管理新理念的剖析以及对系统管理理论和权变管理理论的探讨,建议医院主要领导者除了要对医院内部系统进行管理和改造之外,更重要的是要积极向其他行业学习,应用权变管理理论,对医院外部环境进行评估,随机应变,做出适合自己医院发展的战略决策,引导全体员工大刀阔斧地向前发展。在当前医疗安全形势非常严峻以及医疗改革不明了的情况下,固守张望或迟疑不决的领导者只会将医院引向退却甚至绝路,应引以为戒。
(3)本研究首次提出了全面医疗安全管理的概念和全面医疗安全管理的核心元素、组织构架及其功能,强调政府、医疗行业及全社会共同关心和支持医疗安全管理。总结出了实施全面医疗安全管理的具体措施:全面质量管理、医院医疗安全报告系统、医院重大医疗风险预警指标体系、医院医疗安全管理效果评价体系和创建医院安全文化等,实行从卫生部到基层医院的全国医疗安全一体化管理及反馈制度,见微知著,防微杜渐,共同创建和谐的医患关系,走出一条具有中国特色的医疗安全管理路子,探索并制定出有利于医患安全并切实可行的中国医疗安全管理体系。
Objective: At present, China still do not understand the direction of health care reform, and many hospitals are in waiting for the situation around, although there is a part of the hospital having carried out a series of hospital in-house medical safety management reform and boldly try them, however, because of the lack of the support of a series of medical safety management theory and the recommendation of the research results, our hospital has encountered a critical situation of medical disputes between doctors and patients which was still not controlled and improved effectively, and resulted in a number of hospital administrators confused and lingered. The reason was related to the current health care environment, as well as the defect in medical and safety management theory research. At present, some of the experts in Japan and other countries are putting forward the idea of medical safety management and its implementation, and the United States, Britain, Australia, Japan and other countries learned from the experience and management of aviation safety and afterwards they have made a preliminary attempt and have obtained a better effect. In our country, with the rapid development of the global integration process, medical research has been in the rapid development that medical instruments has emerged, and new treating skills has been renewed with each passing day, thus bringing many patients with confidence and hope, while at the same time, many insecurity risks and blind spots in management are hid to bring a wake-up call to medical health safety management, particularly when the new regulations was introduced, which has become one of the social focuses. How to carry out medical research and theoretical innovation of the systematic medical safety management, how to effectively change the idea of medical safety management and control the happening of medical defects and incidents, and how to adapt to the new situation of ever-changing health care market in order to provide a theoretical basis and the proposed strategy for our government and health administration Management departments, as well as hospital managers, has formed the purpose and the key of this study.
Method: 1. Bibliography Method: to collect a wide range of medical safety management related bibliography, materials and data including the management of aviation safety, hospital medical safety management system, systematical management theory, contingency management theory, and other related theories and methods in and abroad, and to make in-depth analysis after adopting analytic methods of bibliography and data optimized analysis, content analysis, meta analysis, in order to provide theoretical support for exploring key issues and causes of defining the hospital medical safety management system concept, making the core elements of a comprehensive medical safety management, and identifying medical security early warning system and evaluating the system. 2、Delphi method: To investigate the relevant experts by letter. To make a 2-round consultation about the hospital medical safety external environment factors, internal system management risk factors, a comprehensive safety management core elements, and medical safety warning system and its evaluation system by mailed letters, combined with AHP to establish the core elements and the indicator evaluation system. 3、on-site survey method: the research region and object of the study is based at location and economic level as a stratified random basis, 10,9 or 8 provinces in China's eastern, central and western regions were taken as the investigation, and first-class hospitals and second-class hospitals were chose by systematic sampling methods in each provinces according to cities of provincial-level and city-level to carry out research and collect information and data. 27 provinces and 103 hospitals were total surveyed. Data collection methods: hospital situation survey, focus group discussion and expert consultation are included. 4、analytic method: qualitative analytic method and quantitative analytic method are adopted in this study, and qualitative analytic method includes analytic method of descriptive, AHP, cause and effect, FCE, multiple regression and so on. 5, quality control: to identify the source of error to be controlled so as to ensure the reliability of conclusions.
Conclusion: (1) president or vice president had little effects on growth of hospital operation, operating income and medical disputes in the near future, which seemed that the current hospital administrators still failed to find the main reason for growth in medical disputes of the hospital. As hospitals in particular the major hospitals generally has a long history, has formed its own unique culture of itself, even if the hospital leaders could not play the short term impact of the hospital, it will continue to operate, which is very different from enterprises. (2) both of president and vice president regard it important for the doctors and nurses individually and the internal system of the hospital which relates to the medical errors in hospitals, thus taking measures against the medical personnel or internal systems of the hospital, but few resulted, reflecting that the vast majority of hospital leaders lack of contingency management philosophy, who are not good at finding ways to resolve medical disputes outside the hospital environment. (3) there are very few presidents or vice presidents of hospitals are willing to learn from other industries. Most of the current leaders in the hospital taking it as granted as the management experts, so that they are not good at learning from other high-risk industries, and always keeping themselves unable to become a high-reliability organizations, and moreover, China's current hospital operation mode is very different form that of business, so professional managers can not play a greater role in hospital management, thus making China's current dilemma in the realm of hospital management. (4) The ambiguous or hesitated attitude of the government decision-makers often causes hospital managers at a loss and enhances people's dissatisfaction with the hospital, and the medical security will not be guaranteed with medical complaints and disputes inevitably continuing if the government does not consciously guide to reduce the patients' over-expectations about the hospital.
Innovation and recommendations: (1) This study found through a survey questionnaire that: the incidence of medical disputes has increased to varying degrees; hospital administrators still failed to find the main reason for growth in medical disputes of the hospital; the vast majority of hospital leaders lack of contingency management philosophy, who are not good at finding ways to resolve medical disputes outside the hospital environment; there are very few leaders of hospitals are willing to learn from other industries. The safety reporting system, aviation risk analysis systems, disaster early warning indicator system, aviation safety culture and so on adopted in the commercial aviation industry enhance the safety and reliability of aviation as an important factor, which provides a medical safety management with a reference model. (2) By the theory analysis of medical security and systems management and the theory of contingency management, this study proposed that leaders of the main hospitals should pay more importance to actively learning from other industries in addition to the management and transformation of the hospital internal system, apply contingency management theory to assess the hospital external environment and act responding to circumstances, so as to make strategic decisions fit for the development of their own hospitals to guide the staff boldly and resolutely forward. It should take warning from those tenaciously astound or hesitated leaders of hospital who will only lead the retreat and no return on current circumstances of very grim medical security situation and unclear healthcare reform. (3) This study proposed for the first time a total medical safety management concepts and total medical management of the core elements of security, organizational framework and its functions. This study summed up specific measures to implement total medical safety management: total quality management, hospital medical safety reporting system, hospital early warning indicator system of major medical risks, the hospital medical safety management performance evaluation system and the creation of a safety culture in hospitals, etc. The national medical security managing integration from the Health Ministry to the grassroot level hospitals and a feedback system are practiced to show a great significance and protection to promote to create a harmonious relationship between doctors and patients, hence walking in a medical safety management path with Chinese characteristics and exploring to fix the feasible China's practical medical safety management system beneficial to the security between doctors and patients.
引文
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20.U.S.Department of Health and Human Services(USDHHS).Healthy people 2010.Chapters 11(Health Communication) and 15(Injury and Violence Prevention).Washington,DC:USDHHS,Jan 2000.
21.Zeng Guang-ji.The medical quality management system of Australia.Modern Hospital 2005;5(10):1-4
22.姚炜,权变管理理论研究[D]。苏州大学,2003。
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24.Marcus Buckingham,Great Managers Understand Their People,Harvard Business Review,April 11,2005.
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33.夏佳芬.德国医院的全面质量管理,中国护理研究,2004:18(6A):1026
34.Croxall,Colleen L.2001 Michigan hospital CQI/TQM study,The humanities and social sciences,2004;64(12):4615-4616
35.McLaughlin CP,Kaluzny AD.Total quality management issues in managed care.J Health Care Finance.1997;24(1):10-16
36.白曜晖.TQM扩展阶段推行步骤,当代医学,2004:12(9):28
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38.徐敏。试论民用航空安全信息的收集与开发利用。图书馆论坛,2005:25(1):161-163
39.谢瑜,文进,高晓凤,等。国外航空风险管理方法及绩效的循证评价--医疗风险系列研究之一。中国循证医学杂志,2006;6(2):131-138
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42.US Fedral Aviation Authority.US FAR 91.25.Aviation Safety Reporting Program:Prohibition against use of reports for enforcement purposes.1985.
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(1)王小才。医疗安全管理理论与实践研究。中医药管理杂志,1999;9(4):37-40
(2)减少医疗中的失误--是更严肃地对待这个问题的时候了。英国医学杂志中文版,2000;3(1):10-13
(3)杨鸿斌.新形势下医疗安全的对策。医院管理论坛,2004:87(1):14-17
(4)连斌,许敏,孔令曼,等.美国医疗风险管理对我国的启示。中国卫生质量管理,2006:13(1):12-14
(5)长谷川敏彦.医疗安全管理新思路。病院,2003:62(5):402-406
(6) Committee on Quality of Health Care in America,Institute of Medicine To err is human:building a safer health system.Washington,DC:National Academy Press,1999.
(7) Thomas EJ,Studdert DM,Newhouse JP,et al.Costs of medical jinjuries in Utah and Colorado.Inquiry,1999:36:255-264
(8) 阎俊,肖红,杨竞群,等。医疗质量新架构下的医疗事故防范。国外医学护理学分册,2003:22(4):154-157
(9) 陈宁庆。预防医学的新领域--从误诊学角度看美国医疗安全的健康体系。中国误诊医学杂志,2002:2(4):482-484
(10) 刘碧瑶。“失效模式和效果分析”降低医院医疗风险的研究进展。国外医学,2005;2:73-76
(11) Karin Janine Berntsen.How far has healthcare come since "to err is human" exploring the use of medical error data.Journal of Nursing Care Quality.2004;19(1):5
(12) 长谷川敏彦。医疗安全政策の国际动向とその方向性。病院,2002;61(5):402-408
(13) 余震,张亮.全面质量管理及其在医院管理中的应用.中华医院管理杂志,2006:22(7):467-470
(14) O' Leary M,Chappell SL.Confidential incident reporting systems create vital awareness of safety problems.ICAO J,1996;51(8):11-13,27
(15) National Aeronautics and Space Administration.Aviation safety reporting system:program overview.Available at:http://asrs/arc/nasa,gov/overview-nf,htm.Accessed 15 Mar 2000
(16) Shapell S,Weigmann D.A human error approach to accident investigation:the taxonomy of unsafe operations,Int J Aviation Psychol,1997;7:269-291
(17) Committee on Trauma Reseach.National Reseach Council,and the Institute of Medicine. Injury in America:a continuing public health problem.Washington, DC:National Academy Press, 1985.
(18) National Committee for Injury Prevention and Control, Injury prevention: meeting the challenge.Am J Prev Med, 1989;5(suppl 3).
(19) Waller JA. Reflections on a half century of injury control. Am J Public Health, 1994;84(4):664-670
(20) Robertson LS. Injury epidemiology:research and control strategies,2nd ed. New York:0xford University Press, 1998.
(21) U. S. Department of Health and Human Services (USDHHS). Healthy people 2010. Chapters 11 (Health Communication) and 15(Injury and Violence Prevention).Washington, DC:USDHHS, Jan 2000.
(22) Zeng Guang-ji.The medical quality management system of Australia.Modern Hospital, 2005;5(10):1-4
2.杨鸿斌。新形势下医疗安全的对策。医院管理论坛,2004;87(1):14-17
3.张维迎,博弈论与信息经济学[M]。上海:上海人民出版社,2002。
4.王小才。医疗安全管理理论与实践研究。中医药管理杂志,1999;9(4):37-40
5.Committee on Quality of Health Care in America,Institute of Medicine To err is human:building a safer health system.Washington,DC:National Academy Press,1999.
6.Thomas EJ,Studdert DM,Newhouse JP,et al.Costs of medical jinjuries in Utah and Colorado.Inquiry,1999:36:255-264
7.阎俊,肖红,杨竞群,等。医疗质量新架构下的医疗事故防范。国外医学护理学分册,2003:22(4):154-157
8.陈宁庆。预防医学的新领域--从误诊学角度看美国医疗安全的健康体系。中国误诊医学杂志,2002:2(4):482-484
9.刘碧瑶。“失效模式和效果分析”降低医院医疗风险的研究进展。国外医学,2005;2:73-76
10.Karin Janine Berntsen.How far has healthcare come since "to err is human"exploring the use of medical error data.Journal of Nursing Care Quallty.2004;19(1):5
11.长谷川敏彦。医疗安全政策の国际动向とその方向性。病院。2002;61(5):402
12.余震,张亮.全面质量管理及其在医院管理中的应用.中华医院管理杂志,2006:22(7):467-470
13.O' Leary M,Chappell SL.Confidential incident reporting systems create vital awareness of safety problems.ICAO J,1996;51(8):11-13,27
14.National Aeronautics and Space Administration.Aviation safety reporting system:program overview.Available at:http://asrs/arc/nasa.gov/ overview-nf,htm.Accessed 15 Mar 2000.
15.Shapell S,Weigmann D.A human error approach to accident investigation:the taxonomy of unsafe operations,Int J Aviation Psychol,1997;7:269-291
16.Committee on Trauma Reseach.National Reseach Council,and the Institute of Medicine.Injury in America:a continuing public health problem.Washington,DC:National Academy Press,1985.
17.National Committee for Injury Prevention and Control,Injury prevention:meeting the challenge.Am J Prev Med,1989;5(suppl 3).
18.Waller JA.Reflections on a half century of injury control.Am J Public Health,1994;84(4):664-670
19.Robertson LS.Injury epidemiology:research and control strategies,2nd ed.New York:Oxford University Press,1998.
20.U.S.Department of Health and Human Services(USDHHS).Healthy people 2010.Chapters 11(Health Communication) and 15(Injury and Violence Prevention).Washington,DC:USDHHS,Jan 2000.
21.Zeng Guang-ji.The medical quality management system of Australia.Modern Hospital 2005;5(10):1-4
22.姚炜,权变管理理论研究[D]。苏州大学,2003。
23.Fred Luthans,Introduction to Management:A Contingency Approach,McGraw-Hill Book Company,.1976.
24.Marcus Buckingham,Great Managers Understand Their People,Harvard Business Review,April 11,2005.
25.长谷川敏彦,小山秀夫,等主编,张自宽主译。《中外医院》丛书《日本医院管理》,日本NPO法人日中医院交流中心内部编译,2007。
26.罗顺清,郑显兰。日本富山大学附属医院医疗安全管理模式介绍。护理学杂志,2007:22(21):77-78
27.Shiba S,Graham A,Walden D.A new American TQM.Portland,Ore.: Productivity Press,1993
28.Lee TH.A systemic approach to management TQM and planning.Centre for Quality Management Journal.(1994,Fall)
29.Edward de Bono(爱德华)。Lateral Thinking for Management《管理中的横向思维》。企鹅出版社出版,1982年。
30.庄逸洲,等.医疗品质管理学,台湾:华杏出版股份有限公司,2001:270-271,115
31.郑国栋,刘淳仪,等.推行全面品质管理之满意度及员工工作满意度、组织主同感及戴明十四点管理原则认知之初探--以某医学中心为例,医院,2001;19(3):10-22
32.董钰琪,钟国彪,等.综合教学医院推行品质管理与营运绩效之关系研究,中华公共卫生杂志,2000;35(6):1-12
33.夏佳芬.德国医院的全面质量管理,中国护理研究,2004:18(6A):1026
34.Croxall,Colleen L.2001 Michigan hospital CQI/TQM study,The humanities and social sciences,2004;64(12):4615-4616
35.McLaughlin CP,Kaluzny AD.Total quality management issues in managed care.J Health Care Finance.1997;24(1):10-16
36.白曜晖.TQM扩展阶段推行步骤,当代医学,2004:12(9):28
37.白曜晖.TQM整合及持续推行阶段,当代医学,2004:12(10):29
38.徐敏。试论民用航空安全信息的收集与开发利用。图书馆论坛,2005:25(1):161-163
39.谢瑜,文进,高晓凤,等。国外航空风险管理方法及绩效的循证评价--医疗风险系列研究之一。中国循证医学杂志,2006;6(2):131-138
40.Barach P,Small SD.Reporting and preventing medical mishaps lessons from non-medical near miss reporting systems.BMJ,2000:320(7237):759-763
41.(O｜¨)DEG(A｜¨)RD S.Safety management in civil aviation a useful method for improved safety in medical care? Safety Science Monitor;2000;4(1):1-12
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