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

本研究项目由四个子项目组成。(1)对一家民营医院进行了访谈研究，该医院约有400个单元。我就医疗事故中影响说真话和道歉的组织因素采访了医院各科(科)长。受访者常提到的一个重要因素是医院的组织文化和领导力。“在这家医院，领导信任员工的决策，员工信任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。”在医院院长的坚强领导下，组织工作人员之间的这种信任循环正积极地影响着说真话和在医疗失误情况下如果需要的话，道歉。(2)我对卫生保健组织中的日本领导人进行了焦点小组访谈，以检验福斯特和希克的积极心理学领导模式对h…的适用性更多的健康护理领域在美国发展起来。这一模式被用来产生一种积极的心理循环，包括保健工作人员之间以及保健专业人员与病人/家庭之间的信任循环。从采访中，我发现日本卫生保健机构理想领导者的要素与美国有很大不同。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。当我们将美国(西方世界)发展起来的领导力培训模式应用到日本背景下时，我们不仅要复制，而且要修改它，以美国模式作为讨论的催化剂，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就医疗实践问题进行组织研究，因为这对一个组织来说是一个非常敏感的问题。在这种背景下，基于社区的参与性研究(CBPR)似乎有助于克服这一问题，因为这种方法试图让组织人员参与研究，并试图根据他们的需求进行研究。此外，现有的组织研究火焰工作似乎有助于我们制定一份问题清单，以便进一步组织研究影响医疗失误案例中说真话和道歉的因素。(4)战略性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，以更好地应对医疗失误和冲突--这使得组织不仅可以依赖最高领导人或调解人的个人领导和技能，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时，我提出了一个新的(临时)模式：事故的所有利益相关者都应该参与其中。医务人员、管理人员、患者和家属，尽可能地合作讨论1)发生了什么痛苦的事情，2)根本原因是什么，3)所有利益相关者关于根本原因的需求和责任，4)为了更好的未来应该做什么，5)每个利益相关者在未来计划中的角色是什么。较少

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