Key Ethical Issues Encountered in Healthcare Organizations---Perceptions of Healthcare Administrator

Abstract

[[abstract]]SARS 於2003 年春天在台灣急速地漫延，一度帶給民眾極大的恐慌，其主要原因即牽涉到道德的議題，例如: 刻意隱瞞疫情、延遲SARS 疫情的通報、醫療主管機關的隔離政策、醫療院所拒收SARS 病患及醫護人員拒絕照護SARS 病患等。道德的議題在醫務管理的領域中是很重要的，由道德問題衍生之決策不但影響醫療機構本身至鉅，而且影響病人、病人家屬、醫療院所員工甚至擴大到整個社區，所以醫療管理人員更應該比一般人要有較高的道德標準。但是，有關醫療管理人員的道德議題却很少被當做研究的主題，Frederic、Wasieleski及Weber (2000)曾利用22 個電子資料庫對此議題做搜尋，其結果發現有關醫療管理人員的價值觀、道德觀之預設立場及道德發展完全沒有實證資料可查。本研究期望透過有系統的研究方式，來探討台灣的醫療管理人員在其單位中所遭遇到的道德議題，並以此研究做為後續相關研究之先驅。本研究根據行政院衛生署於2002 年底所公布的台灣地區醫院評鑑合格名單之區域醫院及醫學中心的醫療管理人員為研究對象，問卷調查之對象則由該醫院名單中隨機抽樣發放。問卷由研究者自行設計，除參考道德議題相關文獻外，並加入專家訪談之意見，以德爾菲術對問卷做修正，透過前測及信、效度分析做出最後之問卷。9 間醫學中心和22所區域院同意參與本研究。在1000 份問卷中，一共回收566(56.6%)份。本研究主要的結論如下︰ (1)大約58%的填答者同意其所處的組織合乎倫理，而只有大約9%的填答者認為其所處的組織不合乎倫理； (2)前5 大最常面臨的議題分別是︰沒有提供高品質的服務、工作場合中的歧視、缺乏知識或技能、沒有提供誠實的訊息、以及重要敏感訊息的誤用；(3)前5 大工作倫理價值觀分別為︰醫療記錄的保密、公平對待病患、尊敬不同背景的人、遵守專業的標準、以及鼓勵專業發展；(4)個人價值觀是醫療管理人員在解決倫理兩難時，最常用使用的資源。[[abstract]]Healthcare administrative practice involves many ethical issues and ethical decision-making, which would not only effect healthcare organizations themselves, but also patients, patients’families, employees and definitely communities around the organizations. However, the ethical issues related to healthcare administrators have been poorly documented by research. Therefore, the purpose of this study was to investigate the ethical environment of hospitals, the key ethical issues encountered in healthcare organizations, the work ethical values, and resources used to resolve ethical dilemmas as perceived by healthcare administrators. A random sampling of metropolitan hospitals and academic medical centers was selected. Nine academic medical centers and 22 metropolitan hospitals agreed to participate the research. Of the 1000 questionnaires that were mailed to the sample of healthcare administrators, 566 (56.6%) were returned. The major findings of the research were: (1) About 58% of the respondents agreed with the statement that their organizations are ethical and only about 9% considered as unethical; (2) the five top mostly encountered issues were: failure to provide service of the highest quality, discrimination in the work place, lack of knowledge/skills, failure to provide honest information, and misuse of sensitive information; (3) the top five most agreeable work ethical values were: medical record confidentiality, equitable treatment of patients, respectful to different background, compliance to professional standard, and professional development; and (4) personal values were the mostly used resource by healthcare administrators in resolving ethical dilemmas