基于公立医院动态人本化管理的医患冲突预警和干预模式构建

In recent years, the physician-patient conflict is becoming more frequent, and violence caused by it has a trend of upsurge year by year, but systematic research of warning and management is limited. So, it's of great urgency and significance to generate practical risk profile and risk management tool according to the inland hospital and physician-patient conflict characteristics which aims to change the present passive response situation of the hospital, prevent the occurrence of conflicts and minimize the conflict consequence. This study makes the medical activities as the main line, medical staff and patients (including their main families) will be studied in this research and the process of their relationship will be dynamically monitored by means of literature review, questionnaire, physiology and biochemistry tests, behavioral observation, Delphi method, psychological counseling and training. We will determine the risk factors of physician-patient conflict, and then the analysis of the risk factors and construction of an alarming system will be finished based on the information integration system of the hospital. Also, systematic hierarchy intervening measures aim at medical staff, patients and their family members will be devised respectively. Finally, a triune humanistic dynamic management model will be constructed, which means equalization management of hospital and patients conform to the biopsychosocial medical model, psychological diathesis and mental health training to the medical staff and patients that reflecting humanities concerns, and the incorporation of the positive and efficient microcosmic warning and intervening system into the hospital daily activity and workflow.

近年来我国医患冲突逐年上升，暴力恶性事件难以遏制，对医患双方都造成极大伤害和对立，然而宏观的体制性防控失范，微观的系统预警和主动干预匮乏。所以，立足国内特点，制订实用的风险预测和管理工具，改变目前的被动应对、事后处理，最大限度预防冲突发生、减轻后果则具有迫切和重大的社会现实意义。本研究拟以医疗活动为主线，医护人员和患者及其亲属为研究对象，利用文献回顾、量表检测、生化检测、行为观察、专家咨询、心理咨询与训练等方法，动态监测医患人际互动过程，筛选医患冲突的先兆风险因素，以医院内部信息集成系统为依托，完成多向度指标的融合和预警体系的构建，并逐级逐类分别制定针对医护人员、患者和家属以及公立医疗机构优化管理的干预方案，实现三位一体的动态人本化管理模式：即医疗供需双方的平等化管理，契合医学新模式；医护人员心理素质训练和心理健康保健，体现人文关怀；动态有效的微观预警与干预体系，融入医务管理常规流程。

项目背景:医患冲突逐年攀升，以非医疗过失为主，预判和处理难度大，赔偿额度高，医患之间出现信任危机。医患冲突使得医护执业环境恶化，不利于救死扶伤，影响社会和谐，需高度重视。.主要研究内容：拟使用生化检测、行为观察、心理咨询与训练等方法，监测医患人际互动过程，确立先兆风险因素，完成预警体系构建，制定多层级的医疗干预方案。.重要研究结果： .1、攻击行为的反应监控由威胁敏感性与反应抑制共同预测。在威胁敏感性上，个体对攻击性威胁的敏感性高于象征性威胁的敏感性高于现实性威胁的敏感性。在反应抑制上，攻击性威胁下抑制反应时小于象征性威胁下抑制反应时小于现实性威胁下抑制反应时。且随着认知负荷的增加，威胁信息对反应抑制的削弱作用明显，在威胁敏感性上，高冲动性者的威胁敏感性低于低冲动性者的敏感性，高冲动性者的反应抑制受损。威胁类型与冲动性的交互作用显著，高低冲动性者的差异主要体现在象征性威胁和攻击性威胁的加工上。非计划冲动性、行动冲动性和认知冲动均与加工速度有关。.2、医生的“告知不足及患者对医生误解”是引起医疗纠纷的主要原因，“医生突发事件处置经验不足、医生违反诊疗常规、疾病的治疗效果”是造成冲突等级差异的主要原因。通过加强对医护人员突发事件处置的培训、规范医护人员临床操作、提高患者救治率，减少医疗纠纷的发生。.3、患方要加强与医护的信息和情感交流。医方要善于识别医患冲突的先兆行为，拟定预案、强化现场应对技巧，防止冲突发生。运用巴林特小组、正念减压、危机干预、精神心理急救知识等方法,提升医护人员的情绪控制和应对能力，探讨压力管理业务的趋势和方向，进行科普推广。.4、医患关系是医方与患方因医疗活动建立的一种社会关系，有其独特的道德发展模型。医患纠纷的发生受到医护人员、病患及其家属以及社会环境的综合影响，其中医患双方对职业角色的认知和期待以及社会环境的现实是值得我们关注的重要因素。