[[alternative]]The crisis management of NPO--A Case of hospital

[[abstract]] 透過蒐集六所雲林嘉義縣市地區區域教學醫院等級以上之醫院的次級資料，與醫療機構醫療爭議之經辦人員的訪談歷程所蒐集的資料，本研究探究雲林嘉義地區醫療機構醫療爭議處理現況及其差異性，並藉由現行醫療爭議處理之協商模式與危機管理策略的解析，研擬妥適的醫療爭議處理與預防模式，提供相關醫療機構參酌，藉以促進醫療機構執行有效的危機管理，妥適因應醫療爭議，減少醫療爭議對醫病雙方所可能造成的傷害。 研究結果發現，在醫療爭議案件類型中，以「和平理性型」居多，因此，研究者整合歸納出一「協商模式」，即醫療爭議的調處，必須透過不斷的溝通、協商，方能順利化解爭議事件所形成的危機，將傷害減至最低。在協商過程當中，參與的各方皆有其因應策略與介入的方向，各自運籌帷幄，善用談判、磋商技巧，以保障與爭取應有的權益。在當前相關法制尚未健全的情況下，回歸以醫療機構為基礎的協商模式來調處醫病爭議應是難以避免的，故研究者認為此「協商模式」應可適用於大多數的醫療機構，並足供其他有關醫病爭議之調處尚未制度化的醫療機構參考。 研究者亦依據研究目的、文獻資料及研究發現，延展出數項有興趣的研究議題加以深入探討，如醫療爭議調處的經驗模式、志工介入醫療爭議可實踐的方向，及第三者的介入等，期能提供醫界與學界參考，省思和重視醫療爭議調處的相關工作。研究者建議醫療機構應採取妥適的醫療爭議處理與預防模式，平時致力經營和諧的醫病關係、建構一完善的訴願制度、建立醫療爭議制度化與專人專責的處理機制、審慎規劃危機處理的策略或方案、慎選和培養適當的醫療爭議經辦人員、並授予適當的權力與位階，且機構和醫事人員應重視及省思當有的權益與責任，促進醫療爭議獲得適當的處置，以因應或防範醫療爭議案件的發生。另外，亦建議主管單位與立法機關應廣納醫界和各界人士意見，審慎規劃適宜的醫療爭議調處法制，具備公信力與可近性，以減少醫療爭訟，促進醫病和諧。[[abstract]] By collecting the secondary data of six hospitals, which are above the grade of local teaching hospitals, in Yunlin and Chiayi County and by gathering the interviews on record with the staff who transact medical malpractice from these six hospitals, this research explores the current situation and transacting differences of medical malpractice in different medical institutions in Yunlin and Chiayi County . Further, by analyzing the present negotiated models and stratagem for risk management of medical malpractice , this research also draws up appropriate negotiated and preventive models of medical malpractice as the reference for medical institutions to make them practice effective risk management and to appropriately transact medical malpractice, so that the damage to both medical institutions and patients and their family could be lessened. As the result of this research, ＂Rational Type＂ is the major type among medical malpractice cases. Therefore, the researcher induces a ＂Negotiated Model＂, which suggests that medical institution, negotiators who are volunteer, and patient's delegate have to constantly communicate with each other and compromise on conflicts in the process of negotiation, so that the risk caused by the dispute could be solved and the damage could be decreased to the slightest level. During the process of negotiating, each participant should have certain strategy and directing principle to negotiate and confer with skill, to ensure their legal right , and to strive for their benefit. Under the circumstances that the relative laws are not completed, it is necessary to take the medical institution as the basis to negotiate medical malpractice. The researcher supposes this ＂Negotiated Model＂ is applicable to most medical institutions and also can be the reference to the hospitals which are not institutionalized. Meanwhile, according to the research purpose and outcome and reference, the researcher is interested in some issues and extends several relative topics, such as the negotiated experience models of medical malpractice, the practicable guidance for the volunteer to interfere with medical malpractice, and the participation of the third participant, to explore and to make medical and academic circles to think highly of related works of medical malpractice negotiation. The researcher suggests medical institutions should adopt proper transacting and preventative models to conduct medical malpractice. In peace-time, the institutions should devote their time to operate the harmonic doctor-patient relationship, to construct a flawless appealing and complaining institution, to establish a organized system which has special manager to transact medical malpractice, to carefully plan the strategy and proposal for risk management, and to choose and train ideal staff to transact medical malpractice. The staff should be authorized proper authority and suitable position. Both the institution and the staff who practice medical treatment should think highly of their own right and responsibility, make the medical malpractice have proper disposal and prevent the case of medical malpractice from happening. Besides, the researcher also suggests the authorities and the legislature should widely adopt opinions from medical circle and other professionals to legislate appropriate laws to conduct medical malpractice. The laws should be credible and acceptable to decrease the case of medical lawsuit and to promote the harmony between medical practitioner and patient