人性化醫療之建立-醫院個案研究

Abstract

台灣於民國 84 年實施健保制度，繼民國91 年總額給付制度之後，大型醫院紛紛擴床成立，私人財團進入醫療市場，診所林立，醫療環境競爭亦趨激烈。地區醫院如何改革找出一條適合自己的路並健全自己的體質讓其效能及效率增加是迫切的議題。因此，地淤醫院的特色經營與有效地分配資源變得非常重要。 研究目的在於建立“人性化醫療系統”:適合現在小型地區醫院的系統使其人性化醫療流程能夠標準化；使看診與住院過程是有效率的順暢運作，提升醫療品質。研究重點在於探討如何將人性化的部分加入地區醫院，使得其特色可與大醫院與小診所區別出來。期盼將此模式成功的建立起來，不僅能將這樣的知識進行廣泛的應用，更可以研究將此模式複製成連鎖經營的可能性。 本研究以質性個案研究進行，先以文獻探討找出不同使用者對醫院人性化的想法及期盼發展的方向，再經院內舉行幾次焦點團體: 病人團體、醫師團體、護理師團體。每一次以不超過五人來探討醫療人性化醫療對每個團體的具體定義。最後從文獻探討及焦點團體的結果來找出適用於本個案的範疇來組成此院的人性化醫療的照護系統架構。 結果 此個案醫院的人性化醫療照護系統架構：從第一次看診到要開刀手術，人性化醫療系統會提升與醫護人員溝通的雙向性；減輕病人及家屬對未知的不安及減緩術後的不適。術後多方位的照護計畫，讓病人及家屬可以安心地、順利地恢復至原本的生活品質。人性化醫療的建立是一個持續性的建立過程，從剛開始已完成的室內裝修，院內教育訓練、及不同部門對於認同人性化醫療照護計畫的整合需一段時間討論、執行、醫療使用者回饋、矯正、再執行的循環才可往人性化醫療的目標更進一步。

Objective: The objective of this study was to develop a humanized health care plan based on the hospital physician, nurses, patients’ expectation and hospital management’s strategy for the future development. Methods: It is a qualitative case-study approach starting with literature review of humanized health care. Using series of focus group of the hospital patients, nurses and physicians to get the concrete expectation of the humanized health care, then using these focus group’s result and literature review finding juxtapose humanized health care plan. Result: After two rounds of focus group and discussion with management, this case’s humanized health care involved: (1) Communication: include talking attitude and tones, conduct in clear and understandable content and adopting narrative diagnosis in medical session. (2) Clinical process: before surgery explaining pro and cons of the treatment to patient, providing them with the flexibility of treatment choices, setting up surgery process information system to answer most of the doubt, adopting painless treatment during surgery, complete rehabilitation plan after surgery and continue check up. (3) Hospital environment: medical wards and waiting area decorate with homey and comfortable characteristics, giving hospital users a sense of place. Conclusion: Results revealed that, physicians, nurses together with patients of one hospital had developed a three faceted humanistic health care approach that match with their expectation of humanized health care. This approach is original, and, even though participants found it successful, it should be evaluated in terms of hospital users’experience of care in the future.