Preparatory research on organizational factors which affect truth-telling and apology in medical mal-practice and medical conflict cases

该研究项目包括四个子项目。(1)笔者对一家拥有400多个科室的民营医院进行了访谈研究。笔者就影响医疗事故告知与赔礼道歉的组织因素，对该院各科（科）长进行了访谈。受访者普遍提到的一个重要因素是医院的组织文化和领导。“在这家医院，领导信任员工的决策，员工相信他们的领导会保护他们，并在出现问题时为他们的挑战和决策负责。”在医院院长的强有力领导下，组织人员之间的这种信任循环对在医疗事故发生时讲真话和道歉有积极的影响。(2)我对日本医疗机构的领导者进行了焦点小组访谈，以测试福斯特和希克的积极心理学领导模式对日本医疗机构的适用性。 ...更多信息 在美国发展起来的医疗保健领域。这个模式是用来产生一个积极的心理循环，包括医疗保健人员之间的信任循环和医疗保健专业人员和病人/家庭之间。从访谈中，我发现日本医疗保健组织的理想领导者的要素与美国的有很大的不同。在日本，“像父母一样倾听和培养员工”的能力被认为是一种重要的能力，而在美国，“陈述、指导和领导”的能力被认为是一种重要的能力。在将美国（西方世界）发展起来的领导力培养模式应用于日本的情况下，不能简单地照搬，也要加以修改，以美国的模式为催化剂进行讨论，似乎有助于加深日本参与者对领导力的思考。(3)第三方研究人员通常很难对医疗实践问题进行组织研究，因为这对组织来说是一个非常敏感的问题。在这种情况下，基于社区的参与式研究（CBPR）似乎是有用的，以克服这个问题，因为这种方法试图让组织的人在研究，并试图做研究的基础上，他们的需求。此外，现有的组织研究框架工作似乎有助于我们制定一个问题清单，以进一步组织研究的影响因素，在医疗事故的情况下，说实话和道歉。(4)战略建设和平火焰工作将有助于制定组织变革/干预的战略计划，以应对医疗事故和冲突，这使得组织不仅可以依靠最高领导者或调解人的个人领导和技能，而且还可以利用整个组织的资源。在将恢复性司法理念应用于医疗事故和冲突案件中时，我提出了一种新的（临时）模式：事故的所有利益相关者都应参与其中。医务人员，管理人员，病人和家属，在可能的范围内，并合作讨论1）发生了什么痛苦的事情，2）它的根本原因是什么，3）所有利益相关者对根本原因的需求和责任，4）为了更好的未来应该做些什么，5）每个利益相关者在未来计划中的作用。少

This research project consists of four sub-projects.(1) I conducted an interview research with one private hospital which has about 400 units. I interviewed head of each department(section) of the hospital regarding organizational factors which affect truth-telling and apology in medical mal-practice cases. One important factor commonly mentioned by the interviewees was the organizational culture and leadership of hospital."In this hospital, leaders trust their staff's decision making, and the staff trust that their leader will protect them and take responsibility for their challenge and decision making if a problem occurs". This trust-cycle among the organizational staff led by a strong leadership by the hospital head is positively affect truth-telling and apology if needed in case of medical mal-practice.(2) I did focus group interviews with Japanese leaders in health care organizations in order to test the applicability of Foster and Hick's positive psychology leadership model for h … More ealth care field developed in the United States. This model is used to produce a positive psychological cycle including a trust cycle among health care staff and between health care professions and patients/families. From the interviews, I found that elements of ideal leaders in health care organizations in Japan are fairly different from the American ones. In Japan, the ability of "listening and nurturing staff like as a parent" was pointed as an important ability, while in the US, the ability of "stating, directing and leading" was pointed. When we apply the leadership training model which is developed in the United States(the Western World) to Japanese context, we should not just copy but also modify it, it seems to be useful to use the US model as a catalyst for discussion to deepen the Japanese participants' thoughts about leadership.(3) It is generally difficult for a third-party researcher to conduct an organizational research regarding medical practice issues since it is a very sensitive issue for an organization. In this context, community based participatory research(CBPR) seems to be useful to overcome this problem since this methodology tries to involve the organizational people in the research and tries to do research based on their needs. Also, existing organizational study flame work seems to be helpful for us to make a question list of for further organizational research regarding factors which affect truth-telling and apology in medical mal-practice cases.(4) Strategic peacebuilding flamework will be useful to make a strategic plan for organizational change/intervention to respond well to medical mal-practice and conflict-which makes an organization possible not only to rely on only personal leadership and skills of a top-leader or a mediator but also to utilize the resources of entire organization. In application of the idea of restorative justice philosophy to medical mal-practice and conflict cases, I made a new(temporary) model : all stakeholders of the accident should be involved. medical staff, admin staff, patients, and family, to the extent possible, and collaboratively discuss 1) what painful things were occurred, 2) what were root causes of it, 3) What are needs and responsibility of all stakeholders regarding the root causes, 4) What should be done for the better future, 5) what is role of each stakeholders in the plan for future. Less