由病人抱怨探討「以病人為中心之照護」之現況評估—以北部某醫學中心牙科部為例

Abstract

研究背景：自美國Institute of Medicine於1999年開始發表了一系列的醫療品質報告書，點出醫療照護體系的困境，並提出現在醫療照護服務的主要核心理念是以病人為中心，透過以病人為中心的照護，提升醫病關係及改善照護結果，因此若醫療機構提供的醫療服務未能達到病人的期待或需求，病患可能會感到不滿意，甚至進行抱怨。 研究目的：本研究以北部某醫學中心牙科部的病人抱怨內容資料，分析病人抱怨相關資料之分布及抱怨類型，並進一步探討以病人為中心之照護的現況。 研究方法：本研究使用關鍵事件分析法歸納分析北部某醫學中心牙科部，自2008年4月1日至 2012年12月31日止之病人抱怨建言資料，經排除無法進行判讀，以及與抱怨無關的抱怨資料，最後共有238筆病人抱怨事件，291個抱怨議題納入研究。 研究結果：病人抱怨來源中，由患者本人提出之抱怨佔多數，有158件(66.39%)，大約有3成是由非本人投訴抱怨；病人以口頭抱怨投訴之比例為55%，書面投訴方式為45%；科部以說明或解釋的方式回覆病人抱怨之比例約佔73%；病人抱怨的類型共分為5大抱怨面向及33類細項，其中以溝通面向的病人抱怨議題數居多，有115個(39.52%)，其次為治療87個(29.90%)。 結 論：透過病人抱怨資料的分析，發現病人抱怨面向以「溝通」和「治療」為主，說明或解釋為常見的回覆病人抱怨之方式，建議可透過員工教育訓練來改善醫療服務品質，提升以病人為中心之照護，並且發展電子化抱怨管理系統，追蹤病人抱怨的後續處理狀況。

Background： Since 1999, the Institute of Medicine (IOM) of Americian has published a set of quality care reports, indicating that the healthcare system faced many difficulties and proposing that the core value of current healthcare service is patient-centered care, which could be conducted to promote physician-patient relationship and improve health care outcome. In addition, patients make complaints when they are not satisfied with the healrh care service they receive. Objectives： The purposes of this study were to analyse patient complaints of the department of dentistry in a medical center located in northern Taiwan, to determine the frequency and nature of complaints, and further to explore the status quo of patient-centered care. Methods： The current study used Critical Incident Technique to analyze the patient complaints between 1 April 2008 and 31 December 2012. After excluding the complaints that were not readable or without complaint-related content, there were 238 patient complaints and 291 separate issues included in the analyses. Results： 158 of the complaints (66.39%) were made by the patients themselves, and around 30% were made by their relatives. The verbal complaints were 55%, more than the written format (45%). About 73% of complaints were resolved by providing an explanation. The complaints consisted of 5 dimensions and 33 items. 115 issues were related to communication and 87 issues (29.90%) were related to treatment. Conclusions： The majority of patient complaints were related to communication and treatment. Common manner to response patient complaint is to provide an explanation. Therefore, staff training and the development of an electronic complaint management system to track patient complaints were recommended to improve health care quality and patient-centered care.