基于波士顿矩阵的医疗纠纷管理研究

目的针对医疗纠纷赔款案件的危害性进行风险分类分析，为提升科室医疗安全管理水平提供参考。方法分析某院2016年-2019年125例医疗纠纷赔款案件，借鉴波士顿矩阵模型，将医疗纠纷发生科室及原因围绕损害性（均次损害量化值）、损失性［每床位（均次）赔款金额］、发生频次3个指标进行风险分类。结果医疗纠纷赔款案件高发科室主要是骨科（33.6%）和普外科（23.2%），发生原因主要是责任心不强（22.4%）、手术不当（20.8%）、漏诊误诊（16.8%）。“高床位赔款，高损害风险”科室有心外科及普外科，“高床位赔款，低损害风险”科室有泌尿外科、骨科及神经外科；“高赔款，高损害风险”医疗纠纷原因有漏诊误诊、用药不合理、医疗并发症、手术不当，“低赔款，高损害风险”医疗纠纷原因有院内感染、责任心不强。结论波士顿矩阵模型能够为医疗纠纷防范提供风险评估工具，从而助力科室安全管理。管理者可结合风险评估结果，采取差异化管理策略。

Medical Dispute Management Research Based on Boston Matrix

ObjectiveTo classify and analyze the harm of medical dispute compensation cases, and provide reference for medical safety management in departments.MethodsA total of 125 medical dispute compensation cases in a hospital from 2016 to 2019 were analyzed. By referring to the Boston matrix model, the departments and causes of medical disputes were classified according to three indicators: damage (quantified value of damage per time), loss ［amount of compensation per bed (per time)］ and frequency.ResultsThe most common departments of medical dispute compensation cases were orthopedics (33.6%) and general surgery (23.2%), and the main reasons were not strong sense of responsibility (22.4%), improper operation (20.8%), missed diagnosis and misdiagnosis (16.8%). The "high bed compensation, high damage risk" departments included Department of Cardiac Surgery and Department of General Surgery, "high bed compensation, low damage risk" departments included Department of Urology Surgery, Department of Orthopedics and Department of Neuro Surgery. The reasons for "high compensation, high damage risk" included missed diagnosis and misdiagnosis, improper medication, medical complications and improper surgery, while the reasons for "low compensation, high damage risk" included nosocomial infection and weak sense of responsibility.Conclusion The Boston matrix model can provide a risk assessment tool for the prevention of medical disputes, so as to facilitate the safety management of departments. Managers can adopt differentiated management strategies based on the risk assessment results.