Sheuwen Chuang

Taipei Medical University | TMU · Graduate Institute of Data Science

醫療機構對於病人安全文化的關注以及韌性/復原力的推動興趣穩步增長，2014年新版安全態度調查量表(簡稱新版量表)自原來的六構面擴增到八個構面，近年來此項調查每年收集全國超過11萬多名醫療作業人員的回覆，這是一項極為有用的資料。然而，新版量表的運用卻出現直接以「復原力」取代新構面「情緒耗竭」的迷思，且很多的應用是以相關性的分析為主，無法將分析結果帶入實際操作面使用。本文的目的即是引述多方專家論述與研究發現，釐清復原力/韌性、情緒耗竭、病安風氣、與韌性推動之間的關係，以導正此種迷思，並提出未來運用新版量表推動韌性的構想建議，以提升該調查的附加價值，協助醫院有效促進醫療機構韌性的推動。 Hospitals’ interest in promoting patient safety culture...

In this study, we developed a simulation model of detailed in-hospital disaster response to a mass casualty incident based on the analysis of related documents and actual in-hospital disaster response training, aiming to assess the hospital’s response capacity under various disaster situations. This simulation model includes detailed models of pati...

Understanding and learning from hospitals’ resilient behavior or adequate responses to beyond-surge capacity incidents to be better prepare staff for offering patients the appropriate, timely care is imperative. The study adopted the previous findings from the Formosa-Fun-Coast-Dust-Explosion studies as the base of data analysis. We synthesized the...

Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth inter...

Business continuity planning and management (BCP/BCM) is crucial for enterprises such as hospitals and healthcare agencies. However, there is no established method to evaluate the effectiveness and resilience of BCP. In this study, we develop a model for the in-hospital medical processes and resource usage required in mass casualty events. The proc...

Background and Objective : To deal with burn mass casualty incidents (BMCIs), various countries have established national or regional BMCI emergency response plans (ERPs). A burn care capacity ranking model for hospitals can play an integral role in ERPs by providing essential information to emergency medical services for distributing and handling...

Background Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel’s resilience asse...

Taiwan is located on the earthquake-prone circum-Pacific belt and seasonal typhoon impact zone. Given Taiwan's large population and high urban density, disasters can have serious consequences on its economy, environment, and public health. This paper traces the evolution of Taiwan's disaster management system into its current framework under the na...

Objectives: The integrated delivery system (IDS) for ventilator-dependent patients (VDPs) has been in implementation for more than 18 years. This study clarified structural changes and differences in characteristics among hospital networks admitting VDPs. Methods: Social network analysis (SNA) was used to analyze the health insurance data of VDPs d...

Objectives: In recent years, hospitals have actively adopted proactive risk management methods such as failure mode and effects analysis (FMEA). The study explored the deficiencies arising from the applications of FMEA and health care FMEA (HFMEA). Methods: By using the case study method, this study reviewed FMEA and HFMEA case reports provided by...

Objectives: In recent years, hospitals have actively adopted proactive risk management methods such as failure mode and effects analysis (FMEA). The study explored the deficiencies arising from the applications of FMEA and health care FMEA (HFMEA). Methods: By using the case study method, this study reviewed FMEA and HFMEA case reports provided by...

Objective: Nursing shortage in acute care had shown a negative impact on patient safety and nurses. This study determines nurses’ perceptions of hazards affecting patient safety in the intensive care units (ICUs) of a private regional hospital.Methods: An initial focus group was used to explore nurses’ sense of, and experiences with, hazards affect...

Objective The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE). Methods Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical recor...

隨著全球化與科技發展，運用系統思考（systems thinking）釐清並解決複雜問題已是國際產學界的趨勢。在鼓勵創新、師生互動與學生自主的教育趨勢下，專案導向式學習（project-based learning，PBL）被認為是能有效提升教育實踐之方式。因此，本研究目的乃施行整合系統思考與PBL的創新課程。實行方法係採課程設計與田野專案實作方式，課程設計採用階層式議題法的設計原理，將PBL特色結合系統思考理論與方法，並將之分為五個整合教學與實踐的步驟。本研究參與者為本校醫務管理學系2016年第二學期開設系選修課程「系統思考之應用」之選修學生共計8人，專案實施場域為本校附設醫院之周遭區域，專案主題為：「降低醫院周遭隨意丟棄菸蒂」。結果顯示，採用結合系統思考與PBL課程設計提升了學生對於實際...

Purpose: To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. Material and methods: The critical incident tec...

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 follow...

Objective: The integration of quality indicators into the accreditation process has been recognized as a promising strategy worldwide. This study was to explore the implementation patterns of hospital accreditation through the lens of a systems-theory based model, and determine an international accreditation implementation typology. Design: A qu...

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 us...

in Universal Health Insurance – Lessons Learned from Taiwan

in Universal Health Insurance – Lessons Learned from Taiwan

Objectives: There have been a large number of letters to media editors to advocate readers' thoughts on food safety because of recent food industry scandals. Yet, no systematic analysis for these letters has been reported. We conducted a systemic analysis for these opinions and proposed the concept of food safety. Methods: We screened 4 major newsp...

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 Austr...

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 impor...

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 ev...

Objective: 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...

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 satisfact...