医疗品质管理模式.ppt

* * 一封信 ..我目睹當一個病人喪失信心時，所承受的恐懼是如此的可怕.., ..醫生為什麼對於一個臨終的病人都吝於給予一些安慰與鼓勵，他們都是看看而不發一語就走…, ..為什麼不能對躺在床上有意識的病人一些精神上的安慰，至少能讓他走的不要那麼的無助與惶恐.., * * 醫護人員 與 面臨死亡 死亡讓醫護人員四面楚歌 企圖的治療 安撫職業的良心 面對死亡不知道要做些什麼 分享我的無能為力，我的有限及真實的我們 合情合理，含藥效的，習慣性的 增加止痛劑，並不能紓解孤寂 溫柔是很有力量的 不是溫情主義或是多情善感 * * Hope 醫療檢查報告尋求或猜測診斷 尋求最佳解，尋找希望 * * * 24 * 24 The first and second samples, while quite different, both plot inside the control limits indicating no assignable causes are likely to be present. * 24 * 24 However, the third sample plots outside the original distribution, indicating the likely presence of an assignable cause. * 26 With control charts, there are several indicators of assignable causes, all of which are driven by unacceptably low probabilities of occurrence. This slide and the four that follow are expansions of Figure 5.6 showing some common indicators of assignable causes. This chart is an example of a process with no assignable causes. * 27 This chart is of a process with a gradual trend, in this case downward. * 28 This chart illustrates a sudden change in process levels or variability. * 29 This chart shows a process with an excessive number of consecutive points on one side of the center line. Note that gradual trends often are uncovered by this test. * 30 And finally, this chart shows a process with two points actually outside the control limits, an easy indicator to detect but not the only one. These rules, there are a few more, are commonly referred to as the Western Electric Rules and can be found in any comprehensive quality reference. * * Joseph M. Juran品質＝適合使用（fitness to use） TQM 的提倡者 1985年美國國防部創立 Resistance to change (cultural resistance) The root cause of quality issues. ”使用期間能夠滿足使用者的需求” 提供與需求一致的產品(或服務) 醫療的活動與結果能夠符合病人的需求 * * Philip B. Cosbydoing it right the first time 定義品質：『符合要求』 主張：應重於預防而非評估（FMEA） 品質成本：品質非禮物，但是免費的 提供高品質的產品或服務，不一定需要高成本，有時反而可以使成本降低 五大誤會 誤認為高檔、高貴、光鮮奪目的東西即為高品質。 誤認品質是錯綜而複雜的，因此難以測量。 誤以為推行品質需要花錢，必需懂得所謂品質經濟學才能作。 誤以為所有的品質問題都是由現場的工作人員所導致，因此第一線工人的素質決定品質的好壞。 誤以為品質是由品管