及时上报医疗事故、医疗差错信息有利于医院全面整合资源做出应对,抑制

事故影响范围的进一步扩大、影响程度的进一步加深,从长期来看,也有利于医

院服务质量的持续提升。但事实上,医疗人员上报这类信息的意愿并不强烈。尽

管在上级主管部门层面和医院层面均期望通过惩罚体制的建立以惩戒那些瞒报、

迟报行为的责任人,但是从现实来看,这种激励体制的效果值得商榷。基于方式、

方向,激励可分为不同的类别,不同人员、不同情境下,激励的效果也存在差异,

因此需要我们做进一步精细化研究。

本学位论文针对普遍存在的医疗事故、医疗差错信息瞒报、迟报等现象,基

于A医院现实背景,探讨如何通过有效的激励体制的建立而减少此类现象的发

生。具体而言,做了如下四个方面的工作:一、回顾一般性事故_,医疗事故

和医疗差错报告以及激励领域相关文献;二、分析不同方向、方式的激励对医疗

事故、医疗差错瞒报的作用,以及归因等情境变量所起的调节作用;三、基于A

医院为现实案例,通过单个案例分析、多案例比较分析以及实证研究,提炼出激

励体制对报告意愿的作用以及诸多情境变量所起的调节效应,并围绕此拟定了A

医院相关激励体制建立的初步设想;四、基于医疗事故、医疗差错—一步外延,

从负面事件的角度探讨激励方向、方式的选择以及文化建设等对这些负面事件报

告医院的影响。

本文证实奖励比惩罚有效、精神激励比物质激励有效,那么医院为了提高

医疗人员的医疗事故、医疗差错报告意愿就可以从这些方面努力。本文还发现

医生、护士等不同岗位序列下对于激励体制的敏感度不同。类似的,不同职称、

管理层级、甚至于不同的归因倾向下的医疗人员对于激励的敏感度同样有所区

别。这告诫我们应当根据不同的对象釆用不同的激励方式。这些研究结论应用

于A医院、但并不局限与此,本文对其它领域负面事件的探讨结果同样具有借

鉴意义。

关键词:激励体制;医疗事故;医疗差错;奖励;精神激励

Abstract

Timely report the medical accident and medical error information is helpful for

hospital to respond fixlly integrated resources,inhibit accidents' influence to further

expand and deeper degree. In the long run, it's helpful to improve hospital service

quality. But, in fact, medical person usually have weak intent to reported this kind of

information. In spite of the establishment of punishment system in the competent

department level and hospital level happens, but the effectiveness of the incentive

system is questionable. The way, direction, motivation can be divided into different

categories among different people,thus same incentive have different effects in

different situations, so we need to do further refinement.

Based on prevalence of medical accidents, and the phenomenon such as

medical error information conceal, this dissertation takes A hospital as the reality

background and discusses how to establishment of effective incentive system and

reduce the occurrence of such phenomena. In particular, this paper does the

following works from four aspects: first, review the literature about general accident

report, medical accident and medical errors and incentive; Second, analysis

motivation with different direction and different methods on medical accidents or

medical and the moderating effects of situational variables such as the attributional

intent; Three, based on the reality case of A hospital, through single case analysis,

comparative analysis and empirical research, this paper extracts incentive system and

situational variables which may influence the report intent regularly, and this paper

draws up a preliminary idea for related incentive system in A hospital; Four, based

on the medical accident and medical errors for further extension, this paper explore

the choice of direction, method and culture from the perspective of negative events

reports.

This paper confirms that reward is more effective than punishment, spiritual is

more effective than material incentive, so the hospital can take these related efforts

in order to improve the medical staff of medical malpractice. This paper also finds

that the sensitivity of different incentive system is vary according to different jobs

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