面对医疗纠纷的危机管理研究
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摘要
如今医患矛盾不断加深已经成为社会的热点和难点问题。由于医患关系的紧张，致使众多针对医疗机构和医务工作人员的暴力事件剧增，无论是医疗机构还是医务工作人员本身都面临着前所未有的风险和责任。日益频发的医疗纠纷不仅使患者的权益得不到保障，而且严重挫伤了医务工作人员的积极性，阻碍了医学科学的探索和发展。如何更合理地处理医疗纠纷问题，让卫生行政部门和医疗机构甚为头痛，也是医患双方“心中的痛”。可以说，医疗纠纷已经成为影响当今和谐社会构建的一大焦点问题，急需认真研究并找出相应的解决途径。
本文基于系统论、博弈论等管理科学相关理论与方法，围绕“医疗纠纷发生的主要特征、主要原因、主要方式以及如何系统性控制纠纷的发生”等关键性问题，遵循由现象到本质的研究思路，展开深入研究。一是针对我国目前医疗纠纷事件频繁发生的现状，分析了医疗纠纷发生的社会背景，并对我国医疗纠纷发生的类别、特点以及造成的影响进行了梳理和阐述，指出了必须加快解决医疗纠纷这一社会问题的紧迫性和重要性；二是对国内外学者在危机管理，尤其是医疗纠纷危机管理的理论与实践方面的研究加以论述，旨在为后文的研究奠定基础与分析；同时分析比较了西方发达国家在处理医疗纠纷危机中的经验，重点对美国、英国、日本等国家的医疗纠纷处置经验进行了总结，并归纳了几条值得我国学习的经验，即处理医疗纠纷途径必须明确，必须构建和谐的医患关系，媒体要正确引导，同时要应用法制化治理等；三是对我国医疗纠纷处置现状，包括医疗事故的认定，以及医疗纠纷的处置过程和方式进行了分析，指出了我国在处理医疗纠纷事件中存在的主要问题，其中对媒体导向问题、医疗处置的体制问题、医疗责任的保险问题以及法律问题进行了重点分析；四是在大量的调查问卷统计分析的基础上，对我国医疗纠纷发生的主要影响因素，包括社会政府、患者、医院管理、医务工作人员以及医疗过程和医学本身方面的因素加以逻辑诊断和深度分析；五是通过构建相应的博弈模型，重点分析了医患双方就诊时的直面博弈和医患双方发生纠纷时的博弈，以及有第三方机构参与下的医疗纠纷系统主体间的博弈过程，其中第三方包括医疗机构和保险机构；六是在充分认识到解决医疗纠纷的关键是事先预防的基础上，构建了医疗纠纷危机管理系统，重点从危机管理的预防、处置、评估三个阶段分析了医疗纠纷危机管理的过程，同时从媒体、法律和机制三个方面提出了相应的辅助措施。七是以右江民族医学院附属医院为例，实证分析了危机管理在医疗纠纷中的应用。
综上所述，论文采用定性描述和系统科学相结合的方法，通过构建相应的博弈模型和危机管理系统，找出了我国医疗纠纷发生的深层次原因，并有针对性地提出了相应的解决措施，最终建立了医疗纠纷危机管理系统，这对于避免医疗纠纷，保障医疗安全，减少医疗纠纷发生后的不良影响，实现社会的和谐健康发展具有重要的现实意义。当前，我国对医疗纠纷危机管理系统的研究尚处于起步阶段，本文研究仅仅是一次尝试，因此还有待实践的进一步检验并逐步完善。
Now the deepening contradictions between doctors and patients have beenone of the focus and difficult issues in the society.The relations between doctors and patients are strained that there has beena recent upsurge of violence aimed at the healthcare facilities and personnel whofacing the unprecedented responsibilities and risks. Patient's rights couldn't beprotected and the enthusiasm of medical personnel could be severely dampened，which operated against the development of medical science if the treatment disputesare frequent. Medical dispute solution has not only been the pain in the hearts of bothdoctors and patients, but also been the tough issue of the government andhealth administration. The treatment disputes have been one of the key problemsinfluencing the social harmony.We need to study and figure out how to solve it.
This paper surrounds the key problems such as the main features of thetreatment disputes, the main reasons and how to control medical events systematicallybased on related theories and methods of management science such as the systemtheory and the game theory. From phenomenon to essence, the article analyzed thesocial background and declared the types, characteristics and the effectsof medical disputes at the first part. It is necessitous and extremely important tosolve the problem quickly. The second part sketched the theory and practice researchof medical crisis management, especially the medical crisis management theory ofmedical disputes both at home and abroad, which aimed at analyzing and establishingfoundation for the farther research, and also analyzed the experiencesin medical dispute crisis from western countries comparatively and summarized theexperience made by USA, Britain and Japan specifically. This paper concluded someexperiences which are worth to be learned by our country, the way ofresolving medical disputes must be clear, the relationship of doctor–patient must beharmonious and the correct guidance of media and legalization rule must be founded.The third part introduced the handling present situation including the cognizance ofa medical malpractice and the procedure and the mode of medical dispute. Meanwhile;some existing problems were pointed out in this paper and problems such as guide onthe media, system of medical treatment, insurance of medical liability andquestions of law were analyzed specifically. The fourth part analyzed and diagnosed the major effect factors of medical dispute including government, patient,hospital management, medical workers, medical process and medicine itself on thebasis of munificent investigations. The fifth part laid special stress on analyzingthe confronting game of both admission and dispute between doctor–patient and theprocess of game in the participation of third party including medical institution andinsurance industry through the game model. The sixth part constructedwarning system of medical dispute against crisis on the basis of realizing the key tosolve the medical dispute is early prevention, which focused on analyzing crisisidentification, crisis handling, and mechanism of crisis prevention. This partanalyzed specifically the necessity of constructing the warning system against crisis atthe social, patient and hospital aspects. On the basis of analyzing theconstruction principle, the model and the operation mechanism of the warning systemagainst crisis, this part also constructed the warning system against crisis ofmedical dispute and proposed related assisted policies and measures from the media,law, system and mechanism. The seventh gave an empirical analysis of the applicationof crisis management in medical disputes, using the Affiliated Hospital of YoujiangMedical College For Nationalities as an example.
Given all that, the paper adopts the qualitative and quantitative method to findthe deep reasons, corresponding solution and construct the warning systemagainst crisis of medical dispute with the help of game model andmanagement system of crisis. It plays an important role on avoiding medical dispute,protecting medical safe, diminishing the bad effect on medical dispute andcreating a harmonious and healthy society. Presently study in the warning systemagainst crisis of medical dispute at the preliminary stage and further exploration isstill on the way. This thesis is just an attempt.
本文基于系统论、博弈论等管理科学相关理论与方法，围绕“医疗纠纷发生的主要特征、主要原因、主要方式以及如何系统性控制纠纷的发生”等关键性问题，遵循由现象到本质的研究思路，展开深入研究。一是针对我国目前医疗纠纷事件频繁发生的现状，分析了医疗纠纷发生的社会背景，并对我国医疗纠纷发生的类别、特点以及造成的影响进行了梳理和阐述，指出了必须加快解决医疗纠纷这一社会问题的紧迫性和重要性；二是对国内外学者在危机管理，尤其是医疗纠纷危机管理的理论与实践方面的研究加以论述，旨在为后文的研究奠定基础与分析；同时分析比较了西方发达国家在处理医疗纠纷危机中的经验，重点对美国、英国、日本等国家的医疗纠纷处置经验进行了总结，并归纳了几条值得我国学习的经验，即处理医疗纠纷途径必须明确，必须构建和谐的医患关系，媒体要正确引导，同时要应用法制化治理等；三是对我国医疗纠纷处置现状，包括医疗事故的认定，以及医疗纠纷的处置过程和方式进行了分析，指出了我国在处理医疗纠纷事件中存在的主要问题，其中对媒体导向问题、医疗处置的体制问题、医疗责任的保险问题以及法律问题进行了重点分析；四是在大量的调查问卷统计分析的基础上，对我国医疗纠纷发生的主要影响因素，包括社会政府、患者、医院管理、医务工作人员以及医疗过程和医学本身方面的因素加以逻辑诊断和深度分析；五是通过构建相应的博弈模型，重点分析了医患双方就诊时的直面博弈和医患双方发生纠纷时的博弈，以及有第三方机构参与下的医疗纠纷系统主体间的博弈过程，其中第三方包括医疗机构和保险机构；六是在充分认识到解决医疗纠纷的关键是事先预防的基础上，构建了医疗纠纷危机管理系统，重点从危机管理的预防、处置、评估三个阶段分析了医疗纠纷危机管理的过程，同时从媒体、法律和机制三个方面提出了相应的辅助措施。七是以右江民族医学院附属医院为例，实证分析了危机管理在医疗纠纷中的应用。
综上所述，论文采用定性描述和系统科学相结合的方法，通过构建相应的博弈模型和危机管理系统，找出了我国医疗纠纷发生的深层次原因，并有针对性地提出了相应的解决措施，最终建立了医疗纠纷危机管理系统，这对于避免医疗纠纷，保障医疗安全，减少医疗纠纷发生后的不良影响，实现社会的和谐健康发展具有重要的现实意义。当前，我国对医疗纠纷危机管理系统的研究尚处于起步阶段，本文研究仅仅是一次尝试，因此还有待实践的进一步检验并逐步完善。
Now the deepening contradictions between doctors and patients have beenone of the focus and difficult issues in the society.The relations between doctors and patients are strained that there has beena recent upsurge of violence aimed at the healthcare facilities and personnel whofacing the unprecedented responsibilities and risks. Patient's rights couldn't beprotected and the enthusiasm of medical personnel could be severely dampened，which operated against the development of medical science if the treatment disputesare frequent. Medical dispute solution has not only been the pain in the hearts of bothdoctors and patients, but also been the tough issue of the government andhealth administration. The treatment disputes have been one of the key problemsinfluencing the social harmony.We need to study and figure out how to solve it.
This paper surrounds the key problems such as the main features of thetreatment disputes, the main reasons and how to control medical events systematicallybased on related theories and methods of management science such as the systemtheory and the game theory. From phenomenon to essence, the article analyzed thesocial background and declared the types, characteristics and the effectsof medical disputes at the first part. It is necessitous and extremely important tosolve the problem quickly. The second part sketched the theory and practice researchof medical crisis management, especially the medical crisis management theory ofmedical disputes both at home and abroad, which aimed at analyzing and establishingfoundation for the farther research, and also analyzed the experiencesin medical dispute crisis from western countries comparatively and summarized theexperience made by USA, Britain and Japan specifically. This paper concluded someexperiences which are worth to be learned by our country, the way ofresolving medical disputes must be clear, the relationship of doctor–patient must beharmonious and the correct guidance of media and legalization rule must be founded.The third part introduced the handling present situation including the cognizance ofa medical malpractice and the procedure and the mode of medical dispute. Meanwhile;some existing problems were pointed out in this paper and problems such as guide onthe media, system of medical treatment, insurance of medical liability andquestions of law were analyzed specifically. The fourth part analyzed and diagnosed the major effect factors of medical dispute including government, patient,hospital management, medical workers, medical process and medicine itself on thebasis of munificent investigations. The fifth part laid special stress on analyzingthe confronting game of both admission and dispute between doctor–patient and theprocess of game in the participation of third party including medical institution andinsurance industry through the game model. The sixth part constructedwarning system of medical dispute against crisis on the basis of realizing the key tosolve the medical dispute is early prevention, which focused on analyzing crisisidentification, crisis handling, and mechanism of crisis prevention. This partanalyzed specifically the necessity of constructing the warning system against crisis atthe social, patient and hospital aspects. On the basis of analyzing theconstruction principle, the model and the operation mechanism of the warning systemagainst crisis, this part also constructed the warning system against crisis ofmedical dispute and proposed related assisted policies and measures from the media,law, system and mechanism. The seventh gave an empirical analysis of the applicationof crisis management in medical disputes, using the Affiliated Hospital of YoujiangMedical College For Nationalities as an example.
Given all that, the paper adopts the qualitative and quantitative method to findthe deep reasons, corresponding solution and construct the warning systemagainst crisis of medical dispute with the help of game model andmanagement system of crisis. It plays an important role on avoiding medical dispute,protecting medical safe, diminishing the bad effect on medical dispute andcreating a harmonious and healthy society. Presently study in the warning systemagainst crisis of medical dispute at the preliminary stage and further exploration isstill on the way. This thesis is just an attempt.
引文
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