灾难医疗管理之组织人力管理及法律依据

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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FEMAHistoryTheFederalEmergencyManagementAgency-anindependentagencyreportingtothePresidentandtaskedwithrespondingto,planningfor,recoveringfromandmitigatingagainstdisaster.theCongressionalActof1803:Thisact,generallyconsideredthefirstpieceofdisasterlegislation,providedassistancetoaNewHampshiretownfollowinganextensivefire.Inthecenturythatfollowed,adhoclegislationwaspassedmorethan100timesinresponsetohurricanes,earthquakes,floodsandothernaturaldisasters.FEMAHistoryBythe1930s,whenthefederalapproachtoproblemsbecamepopular,theReconstructionFinanceCorporationwasgivenauthoritytomakedisasterloansforrepairandreconstructionofcertainpublicfacilitiesfollowinganearthquake,andlater,othertypesofdisasters.In1934,theBureauofPublicRoadswasgivenauthoritytoprovidefundingforhighwaysandbridgesdamagedbynaturaldisasters.FEMAHistoryTheFloodControlAct,whichgavetheU.S.ArmyCorpsofEngineersgreaterauthoritytoimplementfloodcontrolprojects,wasalsopassed.ThispiecemealapproachtodisasterassistancewasproblematicanditpromptedlegislationthatrequiredgreatercooperationbetweenfederalagenciesandauthorizedthePresidenttocoordinatetheseactivities.FEMAHistoryThe1960sandearly1970sbroughtmassivedisastersrequiringmajorfederalresponseandrecoveryoperationsbytheFederalDisasterAssistanceAdministration,establishedwithintheDepartmentofHousingandUrbanDevelopment(HUD).FEMAHistoryHurricaneCarlastruckin1962,HurricaneBetsyin1965,HurricaneCamillein1969andHurricaneAgnesin1972.TheAlaskanEarthquakehitin1964andtheSanFernandoEarthquakerockedSouthernCaliforniain1971.Theseeventsservedtofocusattentionontheissueofnaturaldisastersandbroughtaboutincreasedlegislation.In1968,theNationalFloodInsuranceActofferednewfloodprotectiontohomeowners,andin1974theDisasterReliefActfirmlyestablishedtheprocessofPresidentialdisasterdeclarations.FEMAHistoryPresidentCarter's1979executiveordermergedmanyoftheseparatedisaster-relatedresponsibilitiesintoanewFederalEmergencyManagementAgency(FEMA).Amongotheragencies,FEMAabsorbed:theFederalInsuranceAdministration,theNationalFirePreventionandControlAdministration,theNationalWeatherServiceCommunityPreparednessProgram,theFederalPreparednessAgencyoftheGeneralServicesAdministrationandtheFederalDisasterAssistanceAdministrationactivitiesfromHUD.CivildefenseresponsibilitieswerealsotransferredtothenewagencyfromtheDefenseDepartment'sDefenseCivilPreparednessAgency.FEMAHistoryJohnMacywasnamedasFEMA'sfirstdirector.Macyemphasizedthesimilaritiesbetweennaturalhazardspreparednessandthecivildefenseactivities.FEMAbegandevelopmentofanIntegratedEmergencyManagementSystemwithanall-hazardsapproachthatincludeddirection,controlandwarningsystemswhicharecommontothefullrangeofemergenciesfromsmallisolatedeventstotheultimateemergency-war.FEMAHistoryThenewagencywasfacedwithmanyunusualchallengesinitsfirstfewyearsthatemphasizedhowcomplexemergencymanagementcanbe.EarlydisastersandemergenciesincludedthecontaminationofLoveCanal,theCubanrefugeecrisisandtheaccidentattheThreeMileIslandnuclearpowerplant.Later,theLomaPrietaEarthquakein1989andHurricaneAndrewin1992focusedmajornationalattentiononFEMA.In1993,PresidentClintonnominatedJamesL.WittasthenewFEMAdirector.Wittbecamethefirstagencydirectorwithexperienceasastateemergencymanager.FEMAHistoryWittinitiatedsweepingreformsthatstreamlineddisasterreliefandrecoveryoperations,insistedonanewemphasisregardingpreparednessandmitigation,andfocusedagencyemployeesoncustomerservice.TheendoftheColdWaralsoallowedWitttoredirectmoreofFEMA'slimitedresourcesfromcivildefenseintodisasterrelief,recoveryandmitigationprograms.Witt'splanswereputtothetestbytheGreatMidwestFloodof1993andCalifornia'smassiveNorthridgeEarthquakeinJanuary,1994.Theagency'stransformationwasrecognizedasanintegralpartoftheClintonAdministration'seffortstoreinventgovernmentandin1995PresidentClintonrecognizedtheagency'saccomplishmentsinhisStateoftheUnionaddress.DomesticTerrorismGuideof