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医疗品质杂志 2020年第2期14卷 34-41页

作者：莊秀文劉淑芬王崇昌李挺宇

目的：近年来医院积极采用预应式风险管理方法。本研究目的是探讨医疗照护FMEA应用所产生的缺失。方法：本研究采个案研究法，检视医院提供之FMEA/HFMEA的个案报告，并比对各项质疑点，综整归纳不合乎FMEA专有名词定义、标准作法、以及... 详细信息

目的：近年来医院积极采用预应式风险管理方法。本研究目的是探讨医疗照护FMEA应用所产生的缺失。方法：本研究采个案研究法，检视医院提供之FMEA/HFMEA的个案报告，并比对各项质疑点，综整归纳不合乎FMEA专有名词定义、标准作法、以及混淆的缺失。结果：收到9家医院资料，研究显示质疑处的统计，以失效模式与失效原因正确性最多，其次为严重度与RPN／危害指数、决策树分析、验证方法。发现有五项缺失顺序为：失效原因大多不是根因、严重度不一致、失效模式与失效原因混淆、决策树分析不明、失效模式与失效影响未清楚呼应。结论：FMEA是推动医院风险管理必要之能力，为增加风险管理的效能，本文建议应加强应用FMEA之系统思考的训练以及技术上的熟稔。

关键词： FMEA HFMEA 系統思考風險管理

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Coping with communication challenges after the Formosa Fun Coast Dust Explosion

Coping with communication challenges after the Formosa Fun C...

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2018 Resilience Week, RWS 2018

作者： chuang, sheuwen Cheng, Chia-Hsin Chen, Hsiao-Chun Lee, Ching-An Woods, David D. Graduate Institute of Data Science Taipei Medical University Taipei Taiwan Fire Department New Taipei City Taiwan Department of Integrated Systems Engineering OH United States

ISBN: (纸本)9781538669136

The Formosa Fun Coast Dust Explosion (FFCDE) occurred on 27 June 2015. It is the largest man-made disaster in Taiwan's history. The paper explores how participating actors dealt with the communication challenges to rescue 499 burn victims from the disaster scene and provide resuscitation and life support for mass burn casualties in hospitals following the FFCDE. Data collection was via review of government reports and journal publications as well as in-depth individual interviews with 36 key participants in this event. Technological communication issues and human related communication issues were identified. The analysis reveals that the remodel of local incident command post at the disaster scene improved the difficulties caused by inadequate communications, and hospital staff' resilience to adapt was based on anticipation in the face of uncertainty and on coordination across roles and units to keep pace with the time varying demands. © 2018 IEEE.

关键词： Hospitals

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Strategies for integrating clinical indicator and accreditation systems to improve healthcare management

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017年第4期10卷 265-274页

作者： chuang, sheuwen Howley, Peter P. Taipei Med Univ Hlth Policy & Care Res Ctr 250 Wuxing St Taipei 11031 Taiwan Taipei Med Univ Sch Hlth Care Adm Taipei Taiwan Univ Newcastle Sch Math & Phys Sci Stat Univ Dr Callaghan NSW Australia

Integrating clinical indicators (CIs) within the accreditation process has become a national priority and proposed policy in Taiwan for continuous quality improvement of healthcare. This study revealed important strategies required to support implementation of such policy. A survey of 249 surveyors was undertaken by questionnaire surrounding the use and perceptions of CIs of four nationwide quality measurement systems (QMSs). Five key messages were identified and interpreted in light of a holistic healthcare systems relationship model: (1) surveyors' use of CIs was positively associated with the level of their understanding of the indicators and hospitals' use;(2) hospital's use of CIs was positively associated with the length of time the QMS existed;(3) surveyors responded to abnormal CIs by assuming auditor, investigator, and/or consultant roles;(4) a gap exists between surveyors' perceptions of CIs' suitability for key parties and their need in the accreditation process;(5) over half of surveyors reported that hospital accreditation needs improvement, with positive and negative comments about using CIs. Developing value-added reports, increased training and support, encouraging surveyors to assume multiple roles, and mandatory CI use would collectively better integrate CIs within the accreditation process and enhance relationships between QMS, hospital accreditation, and healthcare delivery systems.

关键词： Systems improvement Hospital accreditation Accreditation surveyor Quality measurement systems Clinical indicators Continuous quality improvement

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Coping with communication challenges after the Formosa Fun Coast Dust Explosion

Coping with communication challenges after the Formosa Fun C...

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Resilience Week (RWS)

作者： sheuwen chuang Chia-Hsin Cheng Hsiao-Chun Chen Ching-An Lee David D Woods Graduate Institute of Data Science Taipei Medical University Taipei Republic of China Fire Department New Taipei City Republic of China Department of Integrated Systems Engineering Ohio USA

ISBN: (纸本)9781538669143

关键词： Hospitals Iterative closest point algorithm Interviews Personnel Urban areas Explosions Fires

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系統思考之實踐：專案導向式學習教學

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课程与教学 2019年第3期22卷 77-98页

作者：莊秀文陳炯皓王雅萱林均泓陳曉君葉佳幸

随着全球化与科技发展，运用系统思考（systems thinking）厘清并解决复杂问题已是国际产学界的趋势。在鼓励创新、师生互动与学生自主的教育趋势下，专案导向式学习（project-based learning，PBL）被认为是能有效提升教育实践之方式... 详细信息

随着全球化与科技发展，运用系统思考（systems thinking）厘清并解决复杂问题已是国际产学界的趋势。在鼓励创新、师生互动与学生自主的教育趋势下，专案导向式学习（project-based learning，PBL）被认为是能有效提升教育实践之方式。因此，本研究目的乃施行整合系统思考与PBL的创新课程。实行方法系采课程设计与田野专案实作方式，课程设计采用阶层式议题法的设计原理，将PBL特色结合系统思考理论与方法，并将之分为五个整合教学与实践的步骤。本研究参与者为本校医务管理学系2016年第二学期开设系选修课程「系统思考之应用」之选修学生共计8人，专案实施场域为本校附设医院之周遭区域，专案主题为：「降低医院周遭随意丢弃菸蒂」。结果显示，采用结合系统思考与PBL课程设计提升了学生对於实际问题运用系统思考的能力。此种教学方式得以作为其他科目之教学参考。

关键词：專案導向式學習系統思考教育實踐

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Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward

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AMERICAN JOURNAL OF INFECTION CONTROL 2015年第5期43卷 499-505页

作者： chuang, sheuwen Howley, Peter. P. Lin, Shih-Hua Taipei Med Univ Hlth Policy & Care Res Ctr Sch Hlth Care Adm Taipei 11031 Taiwan Univ Newcastle Sch Math & Phys Sci Stat Callaghan NSW 2308 Australia Taipei Hosp Minist Hlth & Welf Dept Infect Control New Taipei City Taiwan

Background: Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals;however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. Methods: Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. Results: No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. Conclusion: To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA. Copyright (C) 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

关键词： Health care-associated infection Systems thinking Scabies outbreak Root-cause analysis Systems-oriented event analysis

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Bayesian methods in reporting and managing Australian clinical indicators

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World Journal of Clinical Cases 2015年第7期3卷 625-634页

作者： Peter P Howley Stephen J Hancock Robert W Gibberd sheuwen chuang Frank A Tuyl School of Mathematical and Physical Sciences\Statistics The University of Newcastle Health Services Research Group Faculty of HealthThe University of Newcastle School of Health Care Administration Health Policy and Care Research CenterTaipei Medical University

Sustained clinical improvement is unlikely without appropriate measuring and reporting techniques. Clinical indicators are tools to help assess whether a standard of care is being met. They are used to evaluate the potential to improve the care provided by healthcare organisations(HCOs). The analysis and reporting of these indicators for the Australian Council on Healthcare Standards have used a methodology which estimates, for each of the 338 clinical indicators, the gains in the system that would result from shifting the mean proportion to the 20 th centile. The results are used to provide a relative measure to help prioritise quality improvement activity within clinical areas, rather than simply focus on "poorer performing" HCOs. The method draws attention to clinical areas exhibiting larger between-HCO variation and affecting larger numbers of patients. HCOs report data in six-month periods, resulting in estimated clinical indicator proportions which may be affected by small samples and sampling variation. Failing to address such issues would result in HCOs exhibiting extremely small and large estimated proportions and inflated estimates of the potential gains in the system. This paper describes the 20 th centile method of calculating potential gains for the healthcare system by using Bayesian hierarchical models and shrinkage estimators to correct for the effects of sampling variation, and provides an example case in Emergency Medicine as well as example expert commentary from colleges based upon the reports. The application of these Bayesian methods enables all collated data to be used, irrespective of an HCO's size, and facilitates more realistic estimates of potential system gains.

关键词： Clinical indicators Improvement System gains Bayesian Statistical models

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Beyond Root Cause Analysis: An Enriched System Oriented Event Analysis Model for Wide Application

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SYSTEMS ENGINEERING 2013年第4期16卷 427-438页

作者： chuang, sheuwen Howley, Peter P. Taipei Med Univ Hlth Policy & Care Res Ctr Taipei 11031 Taiwan Taipei Med Univ Sch Hlth Care Adm Taipei 11031 Taiwan Univ Newcastle Sch Math & Phys Sci Stat Newcastle NSW 2300 Australia

An elementary System Oriented Event Analysis (SOEA) model was developed as an innovative method addressing serious limitations of the traditional root cause analysis (RCA) in healthcare. The SOEA has three distinctive capabilities beyond RCA: multiple events analysis, systems thinking, risk control formulation and alignment. It was applicable to events arising within strict sequential processes. However, for wider application to nonsequential, network system flows, the model needed to be redesigned. The engineering concepts of verification and validation were adopted as guides for the redesign. Patient falls in three differently sized hospitals were used to verify the applicability of the redesigned model. The resulting enriched SOEA model (enSOEA) was later applied in a scabies outbreak case as a validation test of success. This paper aims to describe how the elementary SOEA model was redesigned to achieve the enriched SOEA that is applicable beyond the sequential process, and provides key lessons learned from the tests for promoting its application. (c) 2012 Wiley Periodicals, Inc. Syst Eng 16

关键词： root cause analysis patient safety incident reporting system-oriented event analysis systems thinking

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Using clinical indicators to facilitate quality improvement via the accreditation process: an adaptive study into the control relationship

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INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 2013年第3期25卷 277-283页

作者： chuang, sheuwen Howley, Peter P. Hancock, Stephen Univ Newcastle Sch Math & Phys Sci Stat Callaghan NSW 2308 Australia Taipei Med Univ Hlth Policy & Care Res Ctr Sch Hlth Care Adm Taipei Taiwan Univ Newcastle Fac Hlth Hlth Serv Res Grp Callaghan NSW 2308 Australia

The aim of the study was to determine accreditation surveyors and hospitals use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems. Web-based questionnaire survey. Australian Council on Healthcare Standards (ACHS) accreditation and clinical indicator programmes. Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation;(ii) report use was associated with the use of non-ACHS reports;(iii) a clinical indicator sets perceived usefulness was associated with its reporting volume across hospitals;(iv) simpler measures and visual summaries in reports were rated the most useful;(v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals senior executive and management officers, clinicians, quality managers and surveyors). Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.

关键词： clinical indicators control relationship quality measurement and reporting accreditation systems theory feedback

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An effectiveness analysis of healthcare systems using a systems theoretic approach

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BMC HEALTH SERVICES RESEARCH 2009年第1期9卷 195-195页

作者： chuang, sheuwen Inder, Kerry Univ Newcastle Hlth Serv Res Grp Newcastle NSW 2300 Australia Univ Newcastle Ctr Clin Epidemiol & Biostat Newcastle NSW 2300 Australia

Background: The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. Methods/design: To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Results: Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provi

关键词： Healthcare System Quality Measurement Reporting System Continuous Quality Improvement Communication Relationship

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