随着中国医疗卫生领域改革的深入，医患之间矛盾加剧。医患纠纷不但危及医院发 展，严重者甚至可能影响社会安定。完善医患纠纷危机管理，以缓解医患矛盾，构建和 谐医患关系，成为当务之急。 在国内外医患纠纷危机管理研究的基础上，笔者运用奥古斯丁危机管理六阶段模型 理论，对 A 医院两个医患纠纷案例进行分析。通过分析发现该医院医患纠纷危机管理存 在一些成功经验值得借鉴学习，包括：专门设立医患关系办公室，专职监管医患纠纷危 机，实施首诉负责制，及时组织医院内部信息沟通和组织调查，确定应对预案和介入处 理，根据院内讨论结果明确给予患方解决途径的指引，在案件解决后及时进行案例分析 和更新载入案例库供全院学习。同时，通过案例分析也发现该医院医患纠纷危机管理存 在一些问题，如医疗质量管理有待加强，业务区域视频监控投入不足，患者信息收集和 管理缺失，控制和消除医患纠纷危机乏力，医患沟通不良和存在第三方不当干扰，医患 纠纷案件解决后的评估及整改未得到重视等。针对A医院医患纠纷危机管理存在的问题， 本文提出应加强该医院内外质量监管，加大临床实时监控管理，构建统一患者信息系统， 提升院内外安全保障力度，构建医患之间有效沟通，提升责任评估整改水平，以完善医 患纠纷危机管理，并实现对医患纠纷危机的进一步有效防范和处理。 关键词：医患纠纷；危机管理；案例研究II Abstract With the deepened medical and health care reform in China and the increasingly sharpening conflicts between doctors and patients, the doctor-patient disputes will not only endanger the development of a hospital, but also possibly affect social stability. Accordingly, it is urgent to perfect the crisis management of doctor-patient disputes, ease the conflicts between doctors and patients, and construct a harmonious doctor-patient relationship. On the basis of the domestic and overseas studies on the crisis management of doctor-patient disputes, the author analyzed two cases of doctor-patient disputes in hospital A with six-stage model theory about crisis management put forward by Augustine. It is found through the case analysis that hospital A has some successful experience in crisis management of doctor-patient disputes that is worth learning, for example, there is a special doctor-patient relationship office established in Hospital A specialized in supervising the crisis of doctor-patient disputes, which strictly implements the primary accountability system on first complaint of medical disputes, timely organizes the internal information exchange and investigation inside the hospital, determines the response plan, intervenes in the disputes, provides clear guidance for patients on how to solve the disputes according to the discussion results of the hospital, and timely carries out case analysis and records it in the case database for the reference of the whole hospital. Nevertheless, it is also found through the case analysis that there are certain problems existing in the crisis management of doctor-patient disputes in hospital A, for example, the medical quality management of this hospital needs to be improved; the investment in video monitoring in the hospital business areas is insufficient, the collection and management of patient information are not in place; the performance in controlling and eliminating crisis of doctor-patient disputes is poor; the communication between doctors and patients is not smooth; there is improper interference from third parties, and there is no enough attention paid to the evaluation and rectification after the settlement of doctor-patient disputes. In order to solve the above-mentioned problems existing in the crisis management of doctor-patient disputes in hospital A, some effective precautions and countermeasures are put forward in this thesis, such as enhancing internal and external quality supervision, strengthening clinical real-time monitoring and management, constructing a unified patient information system, enhancing internal and external security, forming an effective communication channel for doctors and patients, and promoting the responsibility assessment and rectification level, in a bid to perfect the crisis management of doctor-patient disputes and realize further effective prevention and handling of the crisis of doctor-patient disputes. Keywords: Doctor-patient dispute; Crisis management; Case studyIII 目 录 摘要.....................................................................................................................................I Abstract ..................................................................................................................................... II 第一章 绪论..............................................................................................................................1 1.1 研究背景 ......................................................................................................................... 1 1.2 国内外研究现状 ............................................................................................................. 2 1.2.1 国外研究现状.......................................................................................................... 2 1.2.2 国内研究现状.......................................................................................................... 4 1.2.3 相关概念的界定...................................................................................................... 6 1.3 研究内容和框架 ............................................................................................................. 6 1.3.1 研究内容和方法...................................................................................................... 6 1.3.2 研究框架.................................................................................................................. 7 第二章 A 医院概况及医患纠纷危机管理现状......................................................................8 2.1 A 医院概况 ..................................................................................................................... 8 2.2 A 医院医患关系办公室 ................................................................................................. 8 2.3 A 医院医患纠纷危机管理现状 ................................................................................... 10 2.4 本章小结 ....................................................................................................................... 13 第三章 A 医院医患纠纷危机管理案例介绍........................................................................14 3.1 住院患者右耳术后面瘫案例 ....................................................................................... 14 3.1.1 案例起因................................................................................................................ 14 3.1.2 案例经过................................................................................................................ 14 3.1.3 案例结果................................................................................................................ 17 3.2 门诊患者无痛胃镜麻醉后猝死案例 ........................................................................... 17 3.2.1 案例起因................................................................................................................ 17 3.2.2 案例经过................................................................................................................ 18 3.2.3 案例结果................................................................................................................ 19 3.3 本章小结 ....................................................................................................................... 20 第四章 A 医院医患纠纷危机管理案例分析........................................................................21 4.1 医患纠纷危机管理模型的选择 ................................................................................... 21 4.2 A 医院医患纠纷危机管理成功经验 ........................................................................... 23IV 4.2.1 日常监管和首诉负责............................................................................................ 23 4.2.2 内部沟通和组织调查............................................................................................ 24 4.2.3 确定预案和介入处理............................................................................................ 24 4.2.4 明确予解决途径指引............................................................................................ 25 4.2.5 案例分析和入库更新............................................................................................ 26 4.3 A 医院医患纠纷危机管理存在问题分析 ................................................................... 26 4.3.1 医疗质量有待加强................................................................................................ 26 4.3.2 视频监控投入不足................................................................................................ 28 4.3.3 信息收集和管理缺失............................................................................................ 28 4.3.4 控制和消除危机乏力............................................................................................ 29 4.3.5 医患沟通不良和第三方干扰................................................................................ 29 4.3.6 评估及整改未得到重视........................................................................................ 30 4.4 本章小结 ....................................................................................................................... 31 第五章 完善 A 医院医患纠纷危机管理过程.......................................................................32 5.1 危机预防阶段加强医院内外质量监管 ....................................................................... 32 5.1.1 医疗安全教育和评分考核.................................................................................... 32 5.1.2 第三方监督及处罚不良行为................................................................................ 32 5.2 危机管理阶段加大临床实时监控管理 ....................................................................... 33 5.3 危机确认阶段构建统一患者信息系统 ....................................................................... 33 5.4 危机控制阶段提升医院安全保障力度 ....................................................................... 34 5.5 危机解决阶段构建医患之间有效沟通 ....................................................................... 35 5.5.1 完善患者知情告知和规范第三方病情见证........................................................ 35 5.5.2 设置医患会谈室关注患者及家属心理疏导........................................................ 36 5.5.3 积极主动并统一口径防止第三方不当干扰........................................................ 36 5.6 危机总结阶段提升责任评估整改水平 ....................................................................... 36 5.7 本章小结 ....................................................................................................................... 37 结 论......................................................................................................................................38。。。。。。以下内容略