Research On Prevention And Control Strategy Optimization Of Medical Disputes

Objective:In this study,four third-level hospitals in Yunnan Province were used as the research object.Through questionnaire surveys of medical staff and medical staff in sample hospitals and in-depth interviews with relevant insiders,the doctors and patients were informed about the knowledge of medical disputes.Views on the causes of medical disputes and the complaints department and dispute resolution channels preferred by medical personnel From the perspective,the optimization strategy for the prevention and control of medical disputes.Methods:In this study,literature search,Delphi,field investigation,descriptive analysis and theoretical analysis were used to study the prevention and control of medical disputes.Using the literature database of the school library to collect the domestic and foreign research literature on the prevention and control of medical disputes,after sorting and refining,it can be used for reference in this study.Combing the etiquette,law and order of medical related behaviors from ancient times to now,sorting out the historical evolution of prevention and control of medical disputes in China,and summarizing the relevant management experience.In the field survey,multi-stage sampling method is adopted.In the first stage,four representative Grade-A hospitals are selected by typical sampling.In the second stage,we use cluster sampling method to randomly select 5 departments from each hospital as the target objects,and use pre-designed questionnaire to investigate the views of all medical staff in the Department and the medical staff in the hospital on the day of investigation on medical disputes.In addition,a semi-structured interview was conducted with relevant insiders,focusing on the current situation of medical disputes,as well as the views of both doctors and patients on each other and the evaluation of medical institutions.In data analysis and data processing,the measurement data satisfying normal distribution is represented by "mean ± standard deviation",and the counting data is represented by"number of cases(%)".T-test or variance analysis is used for the comparison between normal distribution measurement data,chi square test is used for the comparison between count data,Wilcoxon signed rank sum test is used for the comparison between two samples of skew distribution,Kruskal Wallis test is used for the comparison between multiple samples of skew distribution,multiple linear regression analysis is used for the multi factor analysis of measurement data;multi factor analysis of binary classification data Logistic regression analysis was used.Results:(1)The overall awareness of medical staff about medical disputes is better than that of the medical staff.In terms of knowing the score,medical staff(74.99±23.07)were significantly higher than medical staff(44.2±27.8).In the evaluation of the awareness rate,the awareness rate of medical staff(78.8%)is also significantly higher than that of medical staff(35.4%).In the multi-factor analysis of the influencing factors of awareness score and awareness rate,the length of service of medical staff is positively correlated with knowledge status,and the academic qualifications of medical staff are positively correlated with awareness status.(2)Both the doctor and the patient’s views on the cause of the medical dispute have both a consistent performance and a differential performance.In terms of consistency,both the doctor and the patient agree that the top causes of the dispute include the lack of medical knowledge of the patient and family members and the complexity of the patient’s own disease.In the evaluation of the cause of "lack of communication",80.30%of medical staff and 79.62%of medical staff made a choice.The difference is that the medical staff feel that the service attitude/service awareness problem(65.77%)and the hospital management problem(57.31%)are the first reasons for the dispute and the medical staffs evaluation of themselves is inconsistent;in addition,54.62%of the medical staff It is believed that the "problem of medical ethics and medical ethics of medical personnel" is the cause of medical disputes,which is obviously higher than that of medical personnel(32.33%);53.46%of the doctors think that "medical quality problem" is the cause of medical disputes,which is higher than that of medical personnel(43.68%).(3)The ability of medical institutions to handle medical disputes is still insufficient,which is manifested in the following aspects:①The accessibility and pertinence of complaint management are not strong.86.30%of the medical staff knew the location of the dispute complaint,63.17%of the medical staff knew the dispute handling procedure;correspondingly,only 28.46%of the medical staff knew the dispute resolution department,and 14.23%of the medical staff knew the dispute complaint process.②The medical risk taking ability is weak.54.60%of the medical staff understand the medical liability insurance,and 45.38%of the medical staff believe that the cause of the medical dispute is the participation of insurance factors,indicating that both doctors and patients agree on the impact of third-party factors such as medical insurance.For reasons such as unclear advantages,few medical institutions adopt medical liability insurance to share the risk of medical disputes.③On-site treatment capacity of medical disputes needs to be improved.Disputes management within the hospital is generally understaffed and the professional background is not strong,etc.,and due to frequent going out to respond to the complaint,it cannot reach the full reception state.(4)The attitudes and methods of medical staff towards medical disputes tend to be conservative.① Attitude towards medical disputes.Of the 260 medical staff surveyed,53.31%knew the meaning of medical disputes,23.46%knew the Regulations;the overall level of non-litigation resolution of medical disputes was low,59.62%knew mediation,56.92%Of people are aware of negotiation,and 44.23%are aware of arbitration.②There are not many people seeking medical help(less than 10%)in the evaluation of "whose department is unsatisfactory during the medical treatment,which department to complain about".In the evaluation of "the preferred solution method for medical staff when a dispute occurs",more than half of the staff hope to resolve it through voluntary negotiation,which may be in line with the traditional concept of "peace is precious" and the flexible solution of the country ’s advocated by the country.Background.Optimization strategy:The first level prevention as the contact and feedforward control as the guidance strategy:(1)Improve the doctor-patient relationship.Strengthen the construction of medical ethics,improve the level of legal awareness,and unblock communication channels.(2)Optimize hospital operation management.Improve the medical environment,implement the core medical system,pay attention to complaints,and strive for social support.(3)Risk identification,assessment and early warning.Improve risk identification capabilities,strengthen risk assessment,and establish a risk early warning mechanism.The strategy of two-level prevention and on-site control is as follows:(1)Judgment on the nature and extent of medical disputes.Establish a research and judgment mechanism for medical disputes and improve the hierarchical management system of medical risks.(2)Early settlement of medical disputes.Promote non-litigation resolution of medical disputes,and do a good job of linking litigation and mediation.The strategies of three-level prevention and feedback control are as follows:(1)Promote the restoration of normal order.Strengthen the restraint mechanism,eliminate negative impacts,and share social risks.(2)Promote the reform of social collaborative participation.Accelerate the construction of a medical dispute mediation team and promote the progress of the medical-related insurance market.(3)Processing and use of information.Introduce intelligent management and explore the classification prediction model of medical disputes.