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1、灾难医疗管理之组织.人力管理及法律依据,王宗伦 副教授 新光医院急诊科主任,灾难医疗组织管理,组织经营,经营观念 经营策略 组织管理 组织领导,经营观念,健康的重要性 经营观念与管理哲学 环境的变迁二十一世纪医疗服务的趋势 环境的变迁二十一世纪医疗政策的趋势 医疗服务业的本质 医疗机构的经营管理 市场与非市场的力量运作 医疗机构经营管理的未来展望,健康的重要性,全民健康的观念 健康的定义 灾难对健康的冲击,经营观念与管理哲学,经营观念 建立机构经营观念的目的 社会责任的意义 古典观点 社会经济观点 管理哲学 管理的意义 机构经营管理之理想方法 机构经营管理之完整体系,环境变迁二十一世纪医疗服务
2、的趋势,持续增加的医疗需求:灾难效应 逐渐老化的人口:灾难冲击 人口比率快速高龄化 长期照护的需求与困境 门诊化趋势:灾难准备 门诊与住院医疗资源的配置 门诊服务的发展趋势,环境变迁二十一世纪医疗服务的趋势,管理性医疗 医疗科技浪潮 区域医疗网络 执业准则,灾难医疗,环境变迁二十一世纪医疗政策的趋势,新普遍主义的兴起 古典普遍主义与市场机制 新普遍主义 总体效率与个体效率的探讨 总体效率 个体效率 设置医疗优先顺序:灾难考量 重新思考提供者的诱因,医疗服务业的本质,服务业的共同本质 医疗服务业的特点 医疗服务业的努力方向 灾难效应肯定医疗服务的本质,服务业的共同本质,机构组织是由白领阶级主导
3、劳力密集 服务的提供是直接与消费者交易的型态 生产几乎是无形的产品，并且不容易评估其服务品质的优劣,医疗服务业的特点,不确定性 信息不对称,医疗服务业的努力方向,使服务从无形变成有形，让不可见变成可见，建立品牌经营的观念 融合医疗服务标准化与顾客个人化要素 加强机构员工教育训练，以提高服务附加价值 医疗品质控制与管理 了解顾客对服务品质的期望,医疗机构的经营管理,医疗机构的经营型态 医疗服务的发展过程 非营利组织（医疗机构）的经营管理,医疗机构的经营型态,公立医疗机构 私立医疗机构 非营利医疗机构 非营利机构的意义 非营利机构的基本观念,医疗服务的发展过程,人民互助的阶段 慈善赞助的阶段 政府
4、或财团资助的阶段 竞争与市场的阶段,非营利组织（医疗机构）的经营管理,非营利组织的使命 追求经营的绩效 特别注重管理,市场与非市场的力量运作,非市场力量介入的原因 了解非市场力量的重要性 何谓非市场环境 市场与非市场的差异 公私不同 参与者不同 利害影响不同 决定关键不同 合法非法不同 绩效评估标准不同,市场与非市场的力量运作,非市场的要素与策略 医疗机构的非市场策略,医疗机构经营管理的未来展望,从医院管理到医疗管理 策略焦点 运行效率 临床效益 网际网络的运用,911美国恐怖攻击事件,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
