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1、災難醫療管理之組織.人力管理及法律依據,王宗倫 副教授 新光醫院急診科主任,災難醫療組織管理,組織經營,經營理念 經營策略 組織管理 組織領導,經營理念,健康的重要性 經營理念與管理哲學 環境的變遷二十一世紀醫療服務的趨勢 環境的變遷二十一世紀醫療政策的趨勢 醫療服務業的本質 醫療機構的經營管理 市場與非市場的力量運作 醫療機構經營管理的未來展望,健康的重要性,全民健康的理念 健康的定義 災難對健康的衝擊,經營理念與管理哲學,經營理念 建立機構經營理念的目的 社會責任的意義 古典觀點 社會經濟觀點 管理哲學 管理的意義 機構經營管理之理想方法 機構經營管理之完整體系,環境變遷二十一世紀醫療服務
2、的趨勢,持續增加的醫療需求:災難效應 逐漸老化的人口:災難衝擊 人口比率快速高齡化 長期照護的需求與困境 門診化趨勢:災難準備 門診與住院醫療資源的配置 門診服務的發展趨勢,環境變遷二十一世紀醫療服務的趨勢,管理性醫療 醫療科技浪潮 區域醫療網路 執業準則,災難醫療,環境變遷二十一世紀醫療政策的趨勢,新普遍主義的興起 古典普遍主義與市場機制 新普遍主義 總體效率與個體效率的探討 總體效率 個體效率 設定醫療優先順序:災難考量 重新思考提供者的誘因,醫療服務業的本質,服務業的共同本質 醫療服務業的特點 醫療服務業的努力方向 災難效應肯定醫療服務的本質,服務業的共同本質,機構組織是由白領階級主導
3、勞力密集 服務的提供是直接與消費者交易的型態 生產幾乎是無形的產品，並且不容易評估其服務品質的優劣,醫療服務業的特點,不確定性 資訊不對稱,醫療服務業的努力方向,使服務從無形變成有形，讓不可見變成可見，建立品牌經營的觀念 融合醫療服務標準化與顧客個人化要素 加強機構員工教育訓練，以提高服務附加價值 醫療品質控制與管理 瞭解顧客對服務品質的期望,醫療機構的經營管理,醫療機構的經營型態 醫療服務的發展過程 非營利組織（醫療機構）的經營管理,醫療機構的經營型態,公立醫療機構 私立醫療機構 非營利醫療機構 非營利機構的意義 非營利機構的基本觀念,醫療服務的發展過程,民眾互助的階段 慈善贊助的階段 政府
4、或財團資助的階段 競爭與市場的階段,非營利組織（醫療機構）的經營管理,非營利組織的使命 追求經營的績效 特別注重管理,市場與非市場的力量運作,非市場力量介入的原因 了解非市場力量的重要性 何謂非市場環境 市場與非市場的差異 公私不同 參與者不同 利害影響不同 決定關鍵不同 合法非法不同 績效評估標準不同,市場與非市場的力量運作,非市場的要素與策略 醫療機構的非市場策略,醫療機構經營管理的未來展望,從醫院管理到醫療管理 策略焦點 營運效率 臨床效益 網際網路的運用,911美國恐怖攻擊事件,FEMA History,The Federal Emergency Management Agency -
5、 an independent agency reporting to the President and tasked with responding to, planning for, recovering from and mitigating against disaster. the Congressional Act of 1803: This act, generally considered the first piece of disaster legislation, provided assistance to a New Hampshire town following
6、 an extensive fire. In the century that followed, ad hoc legislation was passed more than 100 times in response to hurricanes, earthquakes, floods and other natural disasters.,FEMA History,By the 1930s, when the federal approach to problems became popular, the Reconstruction Finance Corporation was
7、given authority to make disaster loans for repair and reconstruction of certain public facilities following an earthquake, and later, other types of disasters. In 1934, the Bureau of Public Roads was given authority to provide funding for highways and bridges damaged by natural disasters.,FEMA Histo
8、ry,The Flood Control Act, which gave the U.S. Army Corps of Engineers greater authority to implement flood control projects, was also passed. This piecemeal approach to disaster assistance was problematic and it prompted legislation that required greater cooperation between federal agencies and auth
9、orized the President to coordinate these activities.,FEMA History,The 1960s and early 1970s brought massive disasters requiring major federal response and recovery operations by the Federal Disaster Assistance Administration, established within the Department of Housing and Urban Development (HUD).,
10、FEMA History,Hurricane Carla struck in 1962, Hurricane Betsy in 1965, Hurricane Camille in 1969 and Hurricane Agnes in 1972. The Alaskan Earthquake hit in 1964 and the San Fernando Earthquake rocked Southern California in 1971. These events served to focus attention on the issue of natural disasters
11、 and brought about increased legislation. In 1968, the National Flood Insurance Act offered new flood protection to homeowners, and in 1974 the Disaster Relief Act firmly established the process of Presidential disaster declarations.,FEMA History,President Carters 1979 executive order merged many of
12、 the separate disaster-related responsibilities into a new Federal Emergency Management Agency (FEMA). Among other agencies, FEMA absorbed: the Federal Insurance Administration, the National Fire Prevention and Control Administration, the National Weather Service Community Preparedness Program, the
13、Federal Preparedness Agency of the General Services Administration and the Federal Disaster Assistance Administration activities from HUD. Civil defense responsibilities were also transferred to the new agency from the Defense Departments Defense Civil Preparedness Agency.,FEMA History,John Macy was
14、 named as FEMAs first director. Macy emphasized the similarities between natural hazards preparedness and the civil defense activities. FEMA began development of an Integrated Emergency Management System with an all-hazards approach that included “direction, control and warning systems which are com
15、mon to the full range of emergencies from small isolated events to the ultimate emergency - war.“,FEMA History,The new agency was faced with many unusual challenges in its first few years that emphasized how complex emergency management can be. Early disasters and emergencies included the contaminat
16、ion of Love Canal, the Cuban refugee crisis and the accident at the Three Mile Island nuclear power plant. Later, the Loma Prieta Earthquake in 1989 and Hurricane Andrew in 1992 focused major national attention on FEMA. In 1993, President Clinton nominated James L. Witt as the new FEMA director. Witt became the first agency director with experience as a state emergency manager.,FEMA History,Witt initiated sweeping reforms that streamlined disaster relief and recovery operations, ins
