台灣醫療機構執行公開揭露機制之可行性分析

Feasibility analysis of the incorporation of open disclosure practices in medical institutions in Taiwan

目標：衛生福利部已擬定「醫療事故預防及爭議處理辦法」草案，該草案融入歐美先進國家公開揭露機制之作法和精神。未來台灣實際推動該法案，可能遭遇何種障礙和需要哪些配套措施，需進一步探究。方法：除參考國外推動公開揭露經驗的文獻外，以德菲研究法收集國內16名對醫療爭議議題學有專精者的意見，瞭解其對於台灣推行公開揭露機制之障礙和所需配套措施等看法。結果：歷經三回合問卷，專家共提出38項醫療機構推行公開揭露的障礙，其中30個項目具高度共識；共提出41項推行公開揭露所需配套措施，其中34項具高度共識。結論：本研究建議包括：第一，面對醫療不良事件時，醫療機構需破除隱晦和究責個人的管理框架，建立說明真相的機制和組織文化；二是，改善負面或敵對的社會文化與法制，創造處理醫療爭議的友善環境；三是，透過教育訓練建立醫療人員揭露技巧與自信。

Objectives: The Ministry of Health and Welfare has recently drafted a bill entitled “Medical Incident Prevention and Dispute Resolution,” which seeks to incorporate the strategy and content of open disclosure practices that are in place in Europe and the United States. In the event that Taiwan implements this bill, the potential obstacles that may be encountered should be investigated as well as the coordinated set of measures that the bill will require. Methods: In addition to referring to the experience of other countries practicing open disclosure, this study employed the Delphi method to collect opinions from 16 domestic experts on the question of medical disputes. The aim was to analyze the obstacles and evaluate the coordinated set of measures needed to implement open disclosure in Taiwan. Results: After 3 rounds of questionnaires, the experts surveyed proposed 38 recommendations addressing the barriers medical institutions may face when implementing open disclosure. High consensus was reached on 30 of these recommendations. Additionally, 41 recommendations were offered regarding a coordinated set of measures for implementing open disclosure, with high consensus achieved for 34. Conclusions: The recommendations obtained through this research include the following. First, when medical institutions deal with adverse medical events, the tendency of management to conceal and blame individuals should cease. Instead, solutions should be implemented to establish mechanisms and bring changes to the organizational culture to ensure the truth is preserved. Second, improvements are warranted in terms of the hostile social culture and legal system. A friendly environment should be created to ensure that medical disputes are resolved amicably. Third, efforts should be made to foster mature open disclosure behaviors and enhance the confidence of medical staff through education and training.