????: Merit

1
???? Merit DismeritPast, Present Future

• C-G Ker, MD., M.PhD., FACS.
• Professor of Surgery
• ?????
• ????????????
• March 2004

2
1. ??????20??,?????2. ???????? 3. ????????????
3
Hospital Management in Taiwan
Practice control 2004
lt 4
Ker 2004
4
???????

• 1. ?????????
• 2.??????????????????
• 3. ???????,??????
• ????

5

1. ????
2. ????

6
? ? ? ? ? ? ? ? ? ? ?
7
????????

• ??????
• ?????
• ????
• ????
• ????..?

8
??????????
????? ??? ??? ????????
??????? ??? ???? ??????
?????? ????? ???? ?????
??????? TQM, QCC, ISO, ???? ????, ????
???????? ???? ???..
???????? ???? ???..
Accountability
1980
1980-90
1995
2000
2003
9
(No Transcript)
10
???????

• ???????????????????????????????????????????,??
  ?????????????????
• ????ALPHA-???????????

11
??????????

• ????????????
• ????????
• ?????????
• ????????
• ???????????
• ????????

12
????????

• ?????????,
• ??????
• ???,???????

13
???????????

• ???1918????????????????1951?JCAH(???????)??,??????
  ???????????????
• ???????30????????????
• ?????????,???????????????

14
Year of Beginning accreditation operations
By Elma 2003
15
?????????

• ???????? (1978-1987)?
• ?????? (1988-)?
• ???????? (1999-)?

16
????????

• 1978 ??????????,??
• ??(????)?????
• ??(????)?????
• ??(????)?????
• ???????,???74?6????????,?????56??

17
??????

• 1988 ????????????????????????,??????????
• ??????????,?????
• ????(??????)??????
• ????(??????)??????
• ????????????????????

18
????????

• 1999 ??,????????????????????,??????????????????,20
  00 ?????????????????, ?????????????????????
• ???????????11?????,???????4?????,?????????????????
  ??

19
????

• ????????
• ????????,??????????
• ??????????????
• ???????????????????????,???????
• ????????
• ??????,????????????????????????
• ? ?,?????????????????????????
• ??????????????????? ???
• ...???????,????????????????

20
?????????????

• ????????????????????,?
• ?????????
• ?????????
• ?????????
• ??????????,??
• ????
• ????
• ????
• ??????????????
• ???????,?????????

21
?????? ????

• ?????
• ?????

22
Financial Consideration for Hospital Manager

• no money,
• no mission !
• no mission ?

23
???????
24
2003???????????

• ????
• ????
• ????
• ????
• ????

25
????????

• 1999?IOM (Institute of Medicine)????,?????????????
  ?????44,00098,000?
• ??????(Crossing the Quality Chasm)????21??????????
  ???????????????????????????????????

26
WHO?????????-????

• ???????
• ????????(????????)
• ???????
• ?????????(????,?????)
• ????????????????
• ?????????????
• ????????????

27
?????????????

??? 1. ?????????????? 2.??????????????
28
??????

• ???
• ???
• ??????????????
• ?????,????????
• ?????????????????
• ?????????????(???????)???????
• ??
• 2000?????????Patient Oriented???
• 2002???Patient Safety???,????Sentential Events
• 2004????????????
• ??
• 2002??????????????????????
• ????????????

29
????????(I)

• ??????????(Japan Council of Quality Health
  Care,??JCQHC)???1995?7?27??
• ?1985?????????????(????)?????????????????,?1987???
  ??????????,????????????

30
????????(II)

1. JCQHC?1995 ? 1996???????,?????????????????,???????
   ????
2. ???????,?????????????????

31
????????(III)

1. ?1997?7?14?????????????????(?????125?)?
2. 2003?11?25???????????1,076?,????20.41?
3. ???????????????30,??????80.3(????9,239???,??????
   ???1,886?)?
4. 2002?????????????,????????????????

32
????????

• ???????
• ??????????????????
• ????????, ????????
• ????????,??????,???????????????
• ?????????
• ?????????????????,????????????
• ???????
• SARS ?????

33
?SARS?????????????????????

• ?????????????????? 80.1
• ???????????,???????? 85.4
• ??????????????
  53.1
• ???????????????
  60.5
• ??????????????????????? 72.1
• ???????(????)????????? 93.7
• ??????????????????????????
  
  72.9
• ?????????????????????????
  
  73.9
• ????SARS??????????????????????
  
  88.7

34
-???????-??????????????????
35
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???? (????))
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????
????(????)????

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????
36
??????????
???????????? ???????????? ???????????? ?????????? ?????
???? ?????(??)???? ??????(??)???? ???? ?????(??)???? ??????(??)???? ???? ?????(??)???? ??????(??)???? ???? 1.???????????(?????????????????)? 2.???????????? 3.?????????,?????????? 4.????????????
???? ???? ?? ??????? ??????? ???????????? 1.???????????????,?????????????? 2.????????????????????????,??????????,??????,???????????SARS?????RCW?? 3.??????????
???? ???? ?? ??????? ??????? ???????????? 1.???????????????,?????????????? 2.????????????????????????,??????????,??????,???????????SARS?????RCW?? 3.??????????
????? ????? ????? ????? ????????,????????????,??????????????
37
???????????

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38
?????? ??????

1. ????????
2. ?????????????????

39
?????????

• ???????????,????? ?????????????,??????
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• ??????????????????
• ?????????????,????????????????

40
????????

• ???????(??????????
  
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• ????, ?????(medical error)
• ??????????
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41
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• ???????????????,????????????
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• ????????????,????????????????????
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42

• ????????(?SARS)???,???????????,???????(??????,
  ?????????????,???????)?

43
?????????????????,??????????,?????????????,????,??
???????(???????)??????????????????
44
???????????

• ????????????,???????????????????(?????????????????
  ?)
• ????
• ????
• ?????????(medical error)
• ????
• ????

45
??????????? (Customer Community Contribution)

• ??????????????????????????????
• ???????????????,?????????????????
• ????????????????

46
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47
?????????

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• ???????????????????????,??????????????,???????????
  ??????,??????????????????

48
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49
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  ??,?????????,????????????????????
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• ???????????????,???????????????,????????????,?????
  ???????????

50
???????????????

• ??
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51
???????
????(??) 90 ? 91 ? 92 ? 93 ? 94? 95 ? 96 ?
???? ??1?? ?? ??2 ???? ???? ???? ????
???? ???? ???? ??3?? ???? ????
???? ???? ???? ??3?? ???? ????
?1??????????????????,?????????,?????????? ?2??
?????????????,?SARS?????????? ?350?????????????
52
?????????

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53
Expectance of EBM

• Medical care quality.. increased
• Cost containment.. reasonable
• Do medical care
• with evidence

54
????

• ?????????
• ?????

55
???? ? ? ?