「華人戴明學院」是戴明哲學的學習共同體 ,致力於淵博型智識系統的研究、推廣和運用。 The purpose of this blog is to advance the ideas and ideals of W. Edwards Deming.

2007年12月27日 星期四

醫療, 健康與品質報4號 2007/12/28


醫療, 健康與品質報

4 2007/12/28 主編:鍾漢清

創刊 2007/12/25


通信

林老師

我昨天的醫療, 健康與品質報 創刊2號

醫療, 健康與品質報 創刊號

或許多少可解釋某部分原因

其實我相信碰到的可能是特例 特殊因
牙科case我沒說清楚 以後再補充
Quote from W. Edwards Deming:
Manage the cause, not the result.
要真正深究此系統之因 談何容易

更或許不可能呢......



來信:

親愛的老師們大家好

謝謝大家這麼關心醫療品質。
最近,在很多場合,無論是研討會也好或是公部門召開的會議也好
經常聽到兩種人大聲說話,我通常會聽到這樣的說法:
我已經退休了,已經無後顧之憂,可以來做這個了!!
另一種說法就像是楊教授與鍾教授在會場上親身經歷過的醫療環境
不過我想,還是要仔細推敲醫療環境變得如此粗糙背後的原因是什麼?

真的很謝謝大家,我搜尋不到鍾教授與林教授的e-mail,無法將訊息傳送給他
若是有機會,再麻煩各位老師幫我轉送,謝謝。

敬祝  耶誕佳節愉快!新年快樂!

陽明大學社區護理研究所  林詩晴  敬上


台灣:

預防老年人跌倒的多重措施

我「現在」忘記所謂「實施最佳運作模式的七大影響要素」,所以只能以「經驗/照顧」過的兩位中風病人之體認,談一下我所知道的。

首先,中風有「關鍵期間」,不幸的是,親人可能不知道這要點而延誤送醫;醫院可能相當官僚;CT等設備很有限,必須排隊;中風時機可能是倒霉的「周末」,醫院的「戰力」處於停頓狀態(我們可以讀一下沈君山博士所寫的令人驚心動魄的切身經驗談)。

我的岳父在中風(無法言語、行走)十幾年之後才過世。我們很難說清楚在家全天候照顧的種種辛苦。

當然,首先是將四十坪的公寓房間,都改成"近於無障礙的空間"(浴室除外,所以這還需要家人抱入、盥洗等)。這使用之過程,應該可以更系統化: Plan-Do-Study-Act 等,不過當時是靠對於建築設計的直覺。

我們對於"弱勢者"特別設計的設備都還太少,所以主要的娛樂是一 "有線電視"而已(只要想下物理學家 Hawkin的設備即可知 ……

參考不錯的簡介:毛慧芬與林佳琪{銀髮族居家無障礙環境設計}刊於:楊榮森等合著 {彩亮人生}台北:臺大出版中心,2007年, part 7.

黃惠璣論文,國立台北護理學院/ 醫護教育研究所

銀髮族的運動 黃惠璣 - 長期照護雜誌, 2004

應用家庭評估模式於物理治療之經驗-中風個案報告 謝智伶, 黃惠璣 - 物理治療, 2005

A checklist for assessing the risk of falls among the elderly
HC Huang - Journal of Nursing Research, 2004

Assessing Risk of Falling in Older Adults, (co-author) Public Health Nursing, Vol. 30, No.5.

Hip protectors: a pilot study of older people in Taiwan

(TISSUE VIABILITY Hip protectors: a pilot study of older people in Taiwan
RN Hui-Chi Huang, CHL DNSc, SLW PhD - Journal of Clinical Nursing, 2006 - Blackwell Synergy .
Hui-Chi Huang RN, DNSc,Chian-Her Lee MD and Shang-Liang Wu PhD. ... Chen and Huang (2002) and Chu et al. ...)




巴氏量表醜聞
The Barthel Index 巴氏量表 consists of 10 items that measure a person's daily functioning
specifically the activities of daily living and mobility. ...最早是美國醫師發展用於評估住院復健病患進展狀況,在台灣
,長期照護上最常用來評估個案的身體功能。

新竹地檢署昨天指揮搜索拘提全國七所醫院九名醫師到案,這些包括副院長、主任級在內的醫師,涉嫌收賄開具不實的巴氏量表給仲介公司。檢方發現他們每件收取兩萬五千元到六萬元不等金額,以圖利人力仲介業者申請外籍看護工來台,實際大都從事賣淫。


美國

紐約時報系列報導6大死症Six Killers: Alzheimer's Disease:Finding Alzheimer's Before a Mind Fails

其中幾段之英文單字解說,請參見:

· rule of thumb

· in line

· lipid, statin

· trade-off

· countenance

· staunch, Square 1.

· kiss up to

· biomarker


(U.K.) 《每日郵報》說,一種據說可以幫助婦女減肥的藥片Alli 幾個月之後就可以在藥店買到。這種在飯後服用的藥片不需醫生處方就可在藥店購買,每天的花費為1英鎊。

報道說,這種減肥藥據稱可在四個月時間裡將男性和女性的體重減輕5%至10%。有四分之一的人在服用這種減肥藥後表示,他們的體重至少減輕了十分之一。《每日郵報》表示,減肥藥Alli在美國開始銷售後,6個月的銷售額就達到了7500萬美元。Alli的生產商葛蘭素史克公司準備在英國也推出這種藥品。



Wyeth faces a struggle to protect patent exclusivity for Protonix after Teva launched a generic version of the heartburn pill in the U.S.

( heartburn …..胃灼熱英文是heartburn,直譯是「燒心」,但其實不是心臟病,而是消化不良徵候,胃酸升上食道,令胸部有灼熱感覺,口腔有苦味。Heartburn是個不可數名詞(uncountable noun),不可冠以a字,例如:(1) Such food is sure to give you heartburn(這樣的食物,一定會令你胃灼熱)。(2) He took a tablet to relieve his heartburn(他服了一片藥緩解胃灼熱)。 )


英國

英格蘭國民保健系統的九家醫院承認遺失成千上萬病人的資料,政府因此受到猛烈抨擊。

衛生部表示,已經把情況通知了相關病人,目前沒有證據顯示這些資料落入不法之徒的手中。

《星期日鏡報》報道說,在其中一宗事件中,一個存有1.6萬名兒童姓名和地址的光盤失蹤。

這個光盤由地區醫療機構寄給東倫敦一家醫院,但郵件並沒有抵達。在野黨的影子衛生大臣蘭斯裡批評政府沒有好好保護公眾的個人資料。病人權益組織Patient Care的羅賓斯認為,事件只是冰山一角。她說:"由於國民醫療保健計劃(NHS)的人經常粗心大意,很難追究具體的責任人。"

英國政府部門近來不斷發生遺失公眾機密個人資料的事件。本月上旬,北愛爾蘭司機和汽車註冊局(DVLA)在郵寄過程中,丟失了儲存有6,000個人資料的光盤。

當局表示,丟失的個人資料並沒有加密,光盤內裝有7,685輛汽車和6,000多名車主的資料。這些資料包括汽車車主的姓名、地址、車輛註冊年份、發動機號碼、車型和顏色等。今年10月,稅務局遺失兩張記載了所有英國兒童福利補貼申請者個人資料的光盤。這些光盤紀錄了2500萬人的姓名、地址、出生日期、國家保險號碼、銀行資料等。



日本

電動ベッドで窒息死 リモコン不具合か 中国製、4歳児首挟む

2007年12月27日 朝刊

男児がマットレスと枠に首を挟まれ、窒息死した中国製の電動ベッド

写真

 国民生活センターは二十六日、電動リクライニングベッドのマットレスとベッドの枠に、愛知県の男児(4つ)が首を挟まれ、窒息死する事故があったと発表した。リモコンの不具合が原因の可能性があるとみて詳しく調べている。

 愛知県警は販売元などから事情を聴くなどして事故原因を調べている。経済産業省も重大製品事故として事故の内容を公表した。

 センターによると、今月九日午後二時ごろ、男児が持ち上がったマットレスと、木製の天板の間に首を挟まれているのを、父親が発見。病院に運ばれたが、低酸素脳症で死亡した。男児は顔の左のこめかみがヘッドガード、首の右側がマットレスに圧迫されていた。

 センターは「電動ベッドから離れるときはコンセントを抜き、子どもにベッドやリモコンで遊ばせないようにしてほしい」と注意を促している。

 このベッドは埼玉県上尾市の通信販売会社「ベルーナ」が、中国から輸入した「ネオ・ユニバーサル」という製品。男児の父親が二年前にインターネッ トの通信販売で購入した。リモコンには、「上がる」「下がる」のボタンがあるだけで、電源の「入・切」のスイッチはなかった。遺族によると、リモコンにわ ずかな振動が伝わったり、リモコンを裏向きにおいたりした程度で、マットレスが下降の動きを始めることがあったという。

 ベルーナによると、同型のベッドは二〇〇五年四月からこれまでに七百三十六台を販売している。事故を受け出荷を停止した。製品の自主回収を検討し ている。同社は「事故の遺族に対しては深い哀悼の意を表する。事故が商品の欠陥によるものかどうかは、調査結果を待って対応する」とのコメントを出した。

2007年12月26日 星期三

醫療, 健康與品質報 3號 122707

醫療, 健康與品質報

創刊 2007/12/25

3 2007/12/27 主編:鍾漢清

感謝朋友的幫助 請加持......

台灣:

上周五(12/21)下午參加CSQ等等單位合辦的『醫療品質論壇』*,與會專家學者等等都說出許多我們系統中潛在的問題。譬如說,台北榮總內部的許多「炒火洶湧」的餐廳、咖啡店等等,都不合 "美國"等地的醫院安全規定(同樣的,主講人從美國回來,到林口長庚醫院的大廳,一看到許多病人拿/卦著點滴「趴趴走」,簡直快被嚇昏了 …….)。

與會專家還有人提出長庚醫院的績效獎金制度威力大,讓某醫生月入不到兩萬台幣。這不只讓人想到 『裸退』,更讓人想到 Deming的一句名言,值得我們思考:

Quote from W. Edwards Deming:
Forces of Destruction: grades in school, merit system, incentive pay, business plans, quotas.

台灣的系統深受健保局(衛生署)的大影響 所以或許可由學會邀"醫療品質學會"等來談.....


(* 根據王晃三博士 --{醫療保健品質論譠 "Healthcare Quality Forum" 原先翻譯為"醫療照護品質論壇 "}策劃人--給我們的叮嚀(參考 :"專家論譠備忘錄"

……這次論譠鎖定以吳欣宜博士所選定的主題方向,

「用來理解、辨識、推廣的模式架構與導入實施最佳運作模式的七大影響要素。以及

1.慢性病患的系統性主動性照護模式

2.足以確保全天候照護品質的一致性之醫院工作流程再設計

3.預防老年人跌倒的多重措施

4.用藥及轉診管理的保健資訊技術之導入」

討論話題盡可能圍繞這個主題,期能在短時間內聚焦,達成論譠的目標。為方便大家事先醞釀,我建議各位設法上網瀏覽吳博士的相關論文

網址 http://www.rand.org/labor/roybalhp/staff.html . 』)


補充:我的blogs 有中共的問題,他們最近也有一本"興邦之道"參考 安邦之道--國家轉型的目標與途徑 有一章"宏觀"探討

醫療品質方面 {康健雜誌}在2007年7月號對於"配藥出錯防止"等也些專業之討….

我也說過, "康健七月號20007"或可參考 :『樂活咖啡店與聰明醫院
現在你所看到的七月號《康健》封面故事與特別企劃,其實是花了四位作者多個月完成的。直到六月二十四日,林芝 安與朱芷君都還在核對19家醫學中心用藥系統的表格,謹慎仔細,不想出錯。而那之前,她們已不知打了多少電話給各醫院。至於醫院如何使用e 科技做管控以避 免開錯刀給錯藥的採訪報導,更是累積了四個月的功力所得,非常非常用功的結果。(p124- p152)』 我明天會說 這些醫院就是Deming Red Bead Experiment….. 以前思考過為什麼紅珠是20% 看過該期你就知道這太保守


人氣興旺的相關部落格:潘震澤. 老師

http://blog.chinatimes.com/jenntser/


紐約時報報導

Cancer Fight Goes Nuclear, With Heavy Price Tag
By ANDREW POLLACK 1:44 PM ET

A push by medical centers to turn nuclear particle accelerators into weapons against cancer reflects the best and worst of America's health system, experts say.

關於郭台銘先生捐鉅款給台大醫院的"可惜"之嘆 請參考{哈佛商業評論HBR 11月號(2007)}黃達夫先生之見解...........



全球

HC致瑞麟(RL):月前看到Emma (參考杜拉克回憶錄旁觀Emma (Jane Austen ))中的 DENTIST DOCTOR處,特別注意。現在打算編報,所以懇賜翻譯當例子:

DENTIST
ch.16, vol.3, EMMA
She had no difficulty in procuring Isabella's invitation; and she was fortunate in having a sufficient reason for asking it, without resorting to invention. There was a tooth amiss. Harriet really wished, and had wished some time, to consult a dentist. Mrs. John Knightley was delighted to be of use; any thing of ill-health was a recommendation to her; and though not so fond of a dentist as of a Mr. Wingfield, she was quite eager to have Harriet under her care. When it was thus settled on her sister's side, Emma proposed it to her friend, and found her very persuadable. Harriet was to go; she was invited for at least a fortnight; she was to be conveyed in Mr. Woodhouse's carriage. It was all arranged, it was all completed, and Harriet was safe in
Brunswick Square.
RL
版:
艾瑪要取得伊莎蓓拉的邀請函並沒有困難;而且她的運氣很好,有許多充分的理由,並不需要憑藉任何虛構的理由。──一顆牙齒出了毛病。海麗特真的希望去看牙 醫,而且已經希望了好一陣子。約翰奈特利太太很樂意幫忙;舉凡健康不佳的事她都樂於推薦 雖然她對牙醫沒有像對溫費爾德先生那樣喜歡,但是她還是十分熱 心願意照顧海麗特。──當她姊姊這邊安排妥當以後,艾瑪便向她的朋友建議,並且發現她的朋友很快就同意了。── 海麗特決定前往;她受邀至少待兩個星期;是坐伍 郝斯先生的馬車去的。──一切都安排好了,一切都完成了,而海麗特也平安抵達了布蘭茲維廣場
ch.17, vol.3, EMMA
Isabella sent quite as good an account of her visitor as could be expected; on her first arrival she had thought her out of spirits, which appeared perfectly natural, as there was a dentist to be consulted; but, since that business had been over, she did not appear to find Harriet different from what she had known her before. Isabella, to be sure, was no very quick observer; yet if Harriet had not been equal to playing with the children, it would not have escaped her. Emma's comforts and hopes were most agreeably carried on, by Harriet's being to stay longer; her fortnight was likely to be a month at least. Mr. and Mrs. John Knightley were to come down in August, and she was invited to remain till they could bring her back.
RL
版:
伊莎蓓拉如預期的寄來她的客人的詳細情況表;認為在她初抵達的時候悶悶不樂,這種現象完全很自然,因為即將要去看牙醫了;但是,看過牙醫以後,她不覺得海 麗特跟第一天來的時候看到的有什麼不同。當然,伊莎蓓拉不是善於觀察的人;然而如果海麗特不跟孩子們玩的話,那就無法逃過她的觀察了。海麗特打算多住一 段時間,艾瑪得以繼續保持她的舒適和希望;兩星期的時間很可能至少延長為一個月。約翰奈特利夫婦將在八月裡前來,他們邀她住到那個時候再帶她回來。


馬齒

馬的牙齒。由於馬的牙齒隨年齡而添換,所以看馬齒便可知道馬的年齡。穀梁傳˙僖公二年:「荀息牽馬操璧而前曰:『璧則猶是也,而馬齒加長矣。』」後為自稱年歲的謙詞。北周˙庾信˙謹贈司寇淮南公詩:「猶憐馬齒進,應念節旄稀。」

馬的牙齒隨年齡而增長,故看 馬齒即可知馬的年歲。語出穀梁傳˙僖公二年:「荀息牽馬操璧而前曰:『璧則猶是也,而馬齒加長矣。』」後比喻年歲增加。亦作「馬齒長」。

自謙年歲徒增而毫無建樹。如:「虛度六十, 馬齒徒長,事業一無所成。」亦作「馬齒徒增」。

ばし 1 【馬歯】

自分の年齢をへりくだっていう語。馬齢。


在狄更斯{艱難時世}第2章有一場"開宗明義"式的教育對話:

Charles Dickens
Hard Times

Chapter 2
Murdering the Innocents


'Girl number twenty,' said Mr. Gradgrind, squarely pointing with his square forefinger, 'I don't know that girl. Who is that girl?'

'Sissy Jupe, sir,' explained number twenty, blushing, standing up, and curtseying.

'Sissy is not a name,' said Mr. Gradgrind. 'Don't call yourself Sissy. Call yourself Cecilia.'

'My father as calls me Sissy. sir,' returned the young girl in a trembling voice, and with another curtsey.

'Then he has no business to do it,' said Mr. Gradgrind. 'Tell him he mustn't. Cecilia Jupe. Let me see. What is your father?'

'He belongs to the horse-riding, if you please, sir.'

Mr. Gradgrind frowned, and waved off the objectionable calling with his hand.

'We don't want to know anything about that, here. You mustn't tell us about that, here. Your father breaks horses, does he?'

'If you please, sir, when they can get any to break, they do break horses in the ring, sir.'

'You mustn't tell us about the ring, here. Very well, then Describe your father as a horsebreaker. He doctors sick horses, I dare say?'

'Oh yes, sir.'

'Very well, then. He is a veterinary surgeon, a farrier and horsebreaker. Give me your definition of a horse.'

(Sissy Jupe thrown into the greatest alarm by this demand.)

'Girl number twenty unable to define a horse!' said Mr. Gradgrind, for the general behoof of all the little pitchers. 'Girl number twenty possessed of no facts, in reference to one of the commonest of animals! Some boy's definition of a horse. Bitzer, yours.'

The square finger, moving here and there, lighted suddenly on Bitzer, perhaps because he chanced to sit in the same ray of sunlight which, darting in at one of the bare windows of the intensely whitewashed room, irradiated Sissy. For, the boys and girls sat on face of the inclined plane in two compact bodies, divided up the centre by a narrow interval; and Sissy, being at the corner of a row on the other side, came in for the beginning of a sunbeam, of which Bitzer, being at the comer of a row on the other side, a few rows in advance, caught the end. But, whereas the girl was dark-eyed and dark-haired, that she seemed to receive a deeper and more lustrous colour from the sun when it shone upon her, the boy was so light-eyed and light-haired that the self-same rays appeared to draw out of him what little colour he ever possessed. His cold eyes would hardly have been eyes, but for the short ends of lashes which, by bringing them into immediate contrast with something paler than themselves, expressed their form. His shortcropped hair might have been a mere continuation of the sandy freckles on his forehead and face. His skin was so unwholesomely deficient in the natural tinge, that he looked as though, if he were cut, he would bleed white.

'Bitzer,' said Thomas Gradgrind. 'Your definition of a horse.'

'Quadruped. Graminivorous. Forty teeth, namely twenty-four grinders, four eye-teeth, and twelve incisive. Sheds coat in the spring; in marshy countries, sheds hoofs, too. Hoofs hard, but requiring to be shod with iron. Age known by marks in mouth.' Thus (and much more) Bitzer.

'Now girl number twenty,' said Mr. Gradgrind. 'You know what a horse is.'



日本

洋蔥皮茶的開發:健康成分たっぷり 「たまねぎ皮茶」開発

---.JSQC專集 2006年「品質」No.2(Vol.36,No.2,2006

特集『医療の質・安全』

週刊東洋経済 介紹日本的醫師荒和醫院經營之困境

11月5日的{獨賣新聞} 介紹週刊東洋経済 (出版社 東洋経済新報社)

巻号2007/11/3 普通号 --特集 ニッポンの医者、病院、診療所

說它以詳細的 數據資料圖表 介紹日本的醫師荒和醫院經營之困境—四成虧本……(台灣似乎還沒有專業的研究機構….)


『檢查器的transducer 沒更換而傳染C型肝炎(五病人係同一基因)』--這是我的 NHK新聞之記憶,現在可以用朝日新聞的報導詳細補充:

器具使い回し肝炎 5人感染18人疑い 茅ケ崎市立病院

2007年12月26日06時32分

 神奈川県にある茅ケ崎市立病院の循環器内科で心臓のカテーテル検査を受けた60~70代の男性患者5人が、C型肝炎に感染していたことがわかった。25 日、病院が記者会見して明らかにした。感染は昨年12月から今年4月にかけてで、血圧変動を監視する器具「トランスデューサー」を交換せずに使い回したこ とが原因とみられる。メーカーの取り扱い説明書には1回ごとに廃棄するよう記載してある。使い回した理由について担当の臨床工学技士は「手術が立て込んで いて忙しかったから」と説明しているという。他に感染の疑いがある患者が18人おり、病院は検査を受けるよう要請している。

図

  

 病院側の説明によると、5人はいずれも病状に応じた治療を受けており、肝機能は改善しているという。

 感染は今年11月、同病院の消化器内科で肝炎と診断された2人が、同じ日に心臓カテーテル検査を受けていたことから発覚。調査の結果、昨年12月の検査 の際、すでにC型肝炎に感染していた患者から非感染者1人に、今年3月にも同じ感染者から別の非感染者1人に、さらに今年4月には3月に新たに感染した患 者から別の非感染者3人に感染が広がったことが確認された。

 病院側は、最初に感染源となった患者がC型肝炎患者だったことを把握していたという。

 感染経路について、病院側はカテーテル検査で使われたトランスデューサーの可能性が強いとみている。出血を伴う可能性があるカテーテル検 査では、患者の血圧チェックのためにトランスデューサーが使われるが、これが生理食塩水に満たされたチューブを介してカテーテルとつながっていることか ら、この使い回しによって肝炎感染者の血液が次々に非感染者と接したらしい。

 同病院が今年1~10月に行ったカテーテル検査は計276件あったが、1件ごとに使われるべきトランスデューサーは170個しか使われていなかった。

 茅ケ崎市立病院は、病床数401、医師は約70人おり、循環器内科など23の診療科がある。

肝炎救済法案 被害者、裁判所が認定
読売新聞 - 27分前
政府・与党は25日、薬害C型肝炎訴訟の被害者の一律救済法案の概要を固めた。補償対象となる被害者の認定作業は、裁判所が担う。法案は1月7日に国会へ提出する方針だ。福田首相は25日夕、訴訟原告・弁護団6人と首相官邸で初めて面会し、「言葉に尽くせないような ...

創刊號

首相、薬害C型肝炎原告団に謝罪「心からお詫び」 MSN産経ニュース
首相が薬害肝炎でおわび 原告団に、一律救済伝達 東京新聞

現在有英文版本:

Fukuda offers apology to hepatitis C patients

12/26/2007 THE ASAHI SHIMBUN

Prime Minister Yasuo Fukuda met Tuesday with plaintiffs who sued the state and drug makers over their infection of hepatitis C through tainted blood products to apologize for the government's delay in helping them.

"(We) have caused you great hardship both mentally and physically for a long time," Fukuda told the group at the Prime Minister's Official Residence. "I take this opportunity to offer a heart-felt apology."

Fukuda's apology appeared to soothe the hard feelings of the plaintiffs who had sought a meeting with him to help settle the dispute.

"We finally managed to meet the prime minister after trying to do so for the past five years," said Michiko Yamaguchi, who represented the plaintiffs, after the meeting.

They said they urged Fukuda to spell out the government's responsibility in the outline of planned legislation on uniform compensation the ruling coalition plans to compile as early as this week. Fukuda fell short of taking a clear stand on the issue, but told the group he "wants to settle the matter as early as possible."

Fukuda announced Sunday that his ruling Liberal Democratic Party and junior coalition partner New Komeito would sponsor legislation on uniform compensation in an effort to break a stalemate in the court-mediated settlement talks.

The move came amid plunging approval ratings for his Cabinet.

Fukuda apparently agreed to Tuesday's meeting in hopes the main opposition Minshuto (Democratic Party of Japan) will cooperate with passage of the planned legislation.

The talks over the Osaka High Court-mediated settlement proposal had stalled because the plaintiffs demanded uniform compensation for hepatitis C patients. They argued that they and about 800 other hepatitis C patients who are not among the plaintiffs should be given blanket relief, regardless of when they were treated with contaminated blood products.

But the government had insisted on compensating only those who were given tainted blood products during a specific timeframe. This was in line with a ruling by the Tokyo District Court, which, among similar suits, most narrowly recognized the government responsibilities.

The ruling coalition on Tuesday agreed to submit the proposed legislation to the Diet on Jan. 7. The ruling parties want to pass the bill by the end of the current Diet session that winds up Jan. 15.

Senior officials of both parties have been working on the outline of the legislation since Monday. They are likely to invite Minshuto and other opposition parties to work out details of the bill to ensure swift passage.

A central point of the planned legislation will be on wording about the government's responsibility for the public health disaster.

Fukuda on Monday indicated that the bill should touch on this in one way or another, saying it should address the government's "responsibilities or moral responsibilities."

"How the LDP makes a decision on that point will be an important part of the work," he added.

But there is still a gap between the government and the plaintiffs over the extent to which the government should acknowledge its responsibilities in the legislation.

Yamaguchi, visiting senior officials of both ruling and opposition parties Tuesday, called on them to incorporate a passage acknowledging the government's responsibility in causing the damage and allowing it to expand.

Health minister Yoichi Masuzoe said Tuesday at the Upper House health, labor and welfare committee that the government is responsible for having caused a scandal stemming from tainted blood products again and must reflect on its actions.(IHT/Asahi: December 26,2007)

2007年12月25日 星期二

醫療, 健康與品質報 創刊2號

醫療, 健康與品質報

創刊2 2007/12/26 主選者:鍾漢清

全球

永遠的危機 困境 *perpetual crisis

醫療系統太複雜,所以必須分解研究:宏觀(全球、萬國、區域;專業);微觀(組織、個人:體驗、價值觀)

組織診斷要區分是根據研究的research-based change model 或是觀感。

台灣

昨天(071220 星期四)晚上媽從台大醫院的手術房出來。她局部麻醉。所以「所聞到」的手術房之種種聲音,多「不堪入耳」。兩位推床車的護士之一,聽到廣播,竟然衝去聽電話,讓車子傾斜而撞出;雖然另外一位道歉……

nursing station的護士和實習醫生都很忙……

台灣醫界典範人物:林天佑(1913-1995


融合醫學與藝術的外科學大師-林天佑(1913-1995)
林 天佑,台北新莊人,台北帝大醫學博士,他幾項創紀錄的開刀手術留名台灣醫學史,如1951年12月28日首次施行食道癌切除手術成功,此日被台大醫院訂為 「胸腔外科紀念日」,其任外科部主任期間極力發展外科各次專科,並首創「8點朝會制度」提升研究風氣,此制度延續至今已成台大醫院優良傳統之一 。1954 年林天佑發明「手指切肝法」克服肝臟手術的困難,因此揚名國際,成為世界肝臟手術王國,後又發明更簡單的「壓碎肝切法」; 1956 年2月他又完成國內第一例心臟手術,奠立了台大心臟外科的基礎。1976 年他提前退休,投入他向來喜好的文學與藝術,加入「芳蘭美術會」,畫冊有《小螞蟻的足音》、《幻想之旅》、《餘生的腳印》;又出版《象牙之塔春秋記》、 《杏林生涯雲和月》文筆生動感人,實現了他醫學融合藝術的人生夢想。

一般外科學(上) (中) (下)-林天佑25開精裝1386頁
林天佑編:中華現代外科學全書。

《杏林生涯雲和月》台北:台灣商務印書館,1990
退休後(77歲)回憶作品,充滿風趣和智慧。讀它,還可以了解他的許多見解和他擅長的短歌與繪畫。

他當時就認為,各組織 (包括台灣大學醫院等)之"首長" ,最重要的要求其"品質"(第12章 :在一般事業界,……都講究全面品質管理(T. Q. C. Total Quality Control)品質管理圈(Q.C. C. Quality Conrol Circle)。我的看法,不管醫學院,醫院,或其他機關,都應用此方法嚴加管理,做首長者也必須對其所屬部門及設施(包括自動發電設備等等)的品質管理的情況良否,時加掌握。....頁81

他評鑑各醫院時,注意到:大部分的病歷資料都很不周全。
hc看;事隔20年之後,情況似乎沒多大改善。我同洪牙醫談這問題,他指出,初診的資料最重要,原則上務必詳盡。不過,現在健保局每人只給250元,而要想作好它,起碼要花半鐘頭………

我現在在苗栗洪牙醫(洪先生是留日的):我這回討論牙醫的護士。

他說,近半世紀前,日本即有專門牙科護士,而台灣目前還沒有,所以新進者訓練起來頗費事:目前對於新進者,只要求她們有:「無菌」之觀念和懂得皮下注射,其他得從頭教起…….。

我問:為什麼台灣不搞專業護士?洪醫師說,這是醫師公會的問題。

其中一原因是經濟利益,因為美國的,可作清潔洗牙工作,而這是健保給付的 :他們每月這方面收益近十萬。

我剛剛咬合作【植牙】齒模失敗3次,浪費些材料。其實,問題是我搞不清楚,究竟什麼才是醫師所謂「咬合」要求。

普通牙醫機會成本是一小時5000元;植牙者至少三萬

現在是1236, 醫師護士們都還在忙 ……..

美國

紐約時報之文提到 “a public service” 公益服務

紐約時報Boom Times for Dentists, but Not for Teeth By ALEX BERENSON

Published: October 11, 2007

今天的In Kentucky’s Teeth, Toll of Poverty and Neglect –報導牙醫的義舉 榮登傳閱榜首

Stephen Crowley/The New York Times

Liza Brock, 17, was examined at a free clinic set up by Dr. Edwin E. Smith, who drives his mobile dental clinic in Kentucky’s poorest counties.

德國

1008 2007

世上竟有"恐牙医症"!
牙医,大概我们谁都不愿意去看。然而,据统计,德国每十个人当中就有一人单是因为想到要看牙医就会如此惊慌失措,以至于他们干脆不去看牙医,最终后果可能就是牙齿全部坏掉,导致社会关系疏远,甚至于丢掉工作。现在,科学家们发现,这种害怕心理不是过分害怕,而是一种独立的恐惧疾病??恐牙医症,需要进行治疗。

普法伊费尔第一次去看牙医的时候还是一个孩子,那是差不多30来年前的事儿了。那次看牙的经历是痛苦的,疼得非常厉害,让她害怕得要命。这次刻骨铭心的经历,使她后来越来越害怕去看牙医,最后干脆不去了。她描述说:

"有一次去看牙医的时候,我还没出门,感觉就已经糟糕极了。在去牙科诊所的路上,我上了有轨电车就开始脸色发白,心慌意乱,一下车就两眼发黑,扶着旁边的垃圾桶就开始大吐。然后我就对自己说算了,不干了,然后照直坐车回了家。从那以后,我就再也没去看牙医了。认输了。"
普法伊费尔的情况并非罕见。德国有10%的人患有恐牙医症,其典型症状是心慌跳、冒冷汗、以至于昏迷。这种恐惧症对患者生活的各方各面都可以带来极大的影响。德国马堡大学的医学心理学家马格拉夫-斯蒂克斯鲁德博士指出,这些患者的牙齿会越来越坏,牙龈越来越萎缩,使患者越来越不敢张大嘴,因为害怕别人发现他的牙齿不好。他们说话越来越少,开始回避和人接触,有些甚至可能失去工作,原因就在于因为害怕而不敢去看牙医。

科研结果表明,在大部分情况下,这种恐惧症是一系列负面经历所导致的不幸的结果。恐牙医症患者急需专业人员的帮助,这些专业人员不是一般的牙科医生,而是也接受过恐惧症治疗培训的牙科医生。然而,这样的医生德国目前还很少见,其中之一是波鸿的恐牙医症治疗中心的约伦教授。多年来,这位教授就在研究为什么有些人那么害怕去看牙医、怎么才能帮助这些人的问题。在他看来,这一课题被医学界忽视了。研究结果显示,恐牙医症患者表现的是非常明显的恐惧症状,而且恐惧程度轻重不同。令他们最恐惧的是拔智齿和牙科手术,其次最常见的就是打针了,而且对打针的恐惧程度和对拔智齿的差不了多少。有很多人害怕小小的针头。还有一种完全可能的情况是,对大部分患者都不成问题的事儿,比如说清除牙石,却是某些患者最害怕的,因为他们经历过非常疼痛的清除牙石过程,所以对此产生了恐惧心理。

波鸿恐牙医症治疗中心的一个重要的治疗原则是患者第一次来看病的时候,不是先上牙科椅,而是先被请到一间很普通的、没有任何让人见而生畏的牙科器具的诊室,先和医生进行一次详细的谈话。大夫会告诉患者,不光是他害怕看牙医,还有许多其他人也和他同病相怜。大夫也会告诉他,牙科技术已经今非昔比了,毕竟,许多患者最后一次光顾牙医都是15、20年前的事儿了。和那时相比,现在的技术已经大不一样,牙科医生的观念也大不一样,都变得更人性化了,因此,他今天可以享受到的也是和过去完全不同的治疗。当然大夫也会指出,在大部分情况下,患者对自己牙齿状况的估计往往都是不对的。

在波鸿这家特殊牙科医院工作的不仅有牙科医生,还有心理治疗专家,他们密切配合,向患者介绍放松练习,并根据每一位患者个人的恐惧症病情,比如说他最害怕什么、他将将还能承受的是什么、他绝对忍受不了的是什么等等情况,制定相应的治疗方案。据约伦教授告知,大约70%的患者通过这种所谓的"系统性降低敏感度"治疗都获得了痊愈。至于对那30%治疗无效者是否只剩下全身麻醉这一条路可行,专家们的意见还不统一。但有一点他们的看法是一致的,那就是从一开始就避免让这种害怕心理大到不可收拾的地步是非常重要、也更为有效的途径。马堡大学的马格拉夫-斯蒂克斯鲁德博士指出了父母在教育孩子时的一些错误做法。她说:
"让我们搞心理治疗最头疼的情况是小的时候父母搬出牙科医生来吓唬孩子,跟孩子说'你要是不好好刷牙,牙齿上就会有好大的洞,你就得去看牙科医生,那可就疼了!'这大概是最糟糕、最错误的做法。同样不对的做法是带孩子去看牙医的时候,给孩子施加压力,逼孩子说:'快把嘴张开呀!医生都是为了你好,你干吗呢,别给我闹别扭!'"

不久前,"恐牙医症"的内容才被纳入德国医学院牙科专业的学习课程。德国在这一领域的专家至今为数不多,他们试图通过举办各种继续教育活动、通过发表文章,向尽可能多的牙科医生介绍这一话题,鼓励他们不仅关注牙科以手艺为重的一面,也关注它的心理一面。
http://newsletter.dw-world.de/re?l=evwhikI44va89pIa

英國

Image: State-of-Art dentists opens

State-of-Art dentists opens

Small Video Icon

A multi-million pound expansion of The Bristol Dental school has been opened to help treat routine NHS dental patients.

20 Dec 2007

Image: Dental students offering care

Dental students offering care

Small Video Icon

Newcastle dentistry students at tackling a lack of NHS dentists by offering free check-ups.

3 Dec 2007

Large Audio Image

NHS dentist shortage

Small Audio Icon

Spending on health care under Labour has nearly doubled - and yet many people can't find an NHS dentist.

2 Dec 2007

2007年12月23日 星期日

theory (W. Edwards Deming:)

Quote from W. Edwards Deming:
Every theory is correct in its own world, but the problem is that the theory may not make contact with this world.

W. Edwards Deming Institute

陳寬仁懷念劉老

經過十幾年的時光摧人,現在,我覺得陳老師在1995 年的這種文字也是難得,所以特別轉載於此,並向陳老師致謝:


陳寬仁老師致hc:「翻舊檔發現一段文字 應是84年間事罷」



     無限的懷念           陳寬仁
 
      那天我因事到學會去,瞄到理事長晃三兄坐在圖書室中,我一腳踏進去正想問他:
「你今天怎麼會在這裡?」話沒說出口,他一臉肅穆的仰起頭問我:「你聽見消息沒有?」
看他的表情、聽他的聲音,猜到有什麼大事發生了,他接著說:「是劉老,他 … … 」
      當時,我說了「啊呀!我答應要給他的錄影帶一直沒有弄好!」晃三兄說:
「你說什麼?」不過、他沒有聽我解釋就忙別的事去了。
      去年暑假我去了四川省,在成都住了五六天,又南下到樂山去看大佛、上了峨眉山
金頂。一路上我都帶著V8錄影機拍攝風景和名勝古蹟。
      回來後,有一次趁天氣好去看劉老,他倆老夫婦請我在他家巷口一家館子吃飯聊天,
從台南聊起,因為、我們正式有交情是他在台南擔任中國生產力中心南區主任時開始。那時,
我們曾有一段對話,很有意思。
      「你的南區有多大?從那裡到那裡?」我問他。
      「除了台北市不管,台北市以外我都管!」
       外表看起來,劉老好像不是有多大魄力的人,可是在民國六十年代到處辦訓練推廣
工業工程,辦講習班從台南出發、開班一直開到宜蘭和新竹,高雄、嘉義、台中那是不在話下。
「當然,不好意思到台北開班!」當年劉老說這句話時臉上的一點詭秘神情,我仍然記得。
開班時,「製程管制」一課大多數是由我擔任,上課那幾天只要他在,晚上的一頓飯,他總是
請我去吃日本菜。去日本館子我們都不會點菜,不過、劉老說:「清爽,不油膩,我們喝點
啤酒,好聊天。」
      他擔任「品質管制」月刊主編時,追著我要稿子也很兇悍。
      他退休後遷來台北,我們見面不多;他又從學會理事退休後我們見面更少。
最近幾年、偶然想起要去看看他,先要等天氣晴朗然後打電話過去問:「精神好不好?過來
看看你、怎樣?」他說好,我才過去。但是、一見面他就喜歡過問有關學會的事。
      有一次想起他說過、抗日戰爭時代他們在成都住了七八年,於是,我把我在成都附近
所拍攝的V8錄影帶剪接成一段七十幾分鐘的VHS大帶,寄給他,看了帶子後他高興得不得了,
在電話裡大聲訴說成都,說個不停,終於沒有問起學會的事了。
 
我說:「你有興趣看,我再把樂山大佛和峨眉山的帶子剪接好寄一卷給你!」他在電話那一端
謝了好幾聲。可是我最近忙著搬家,忙著些雜事,而且剪接影帶的設備都打包收起來了。
      可是、劉老沒有等待我把帶子做好、就走了。而且帶子即使做好,也少了一位最熱心的
欣賞人了!唉,劉老!

Census sensitivity


由於人口調查牽涉到許多Deming理論的發展

所以我們姑且一笑讀之

Counting people

Census sensitivity

Dec 19th 2007

Numbers mean power, which is why counting people is so controversial

AFP

“GO, NUMBER Israel from Beersheba even to Dan; and bring the number of them to me, that I may know it.” It was not the first census described in the Bible, nor the last, nor yet the most renowned. But for reasons that are obscure, King David's order to Joab, the commander of his army, went against God's will and both men knew it. The count was carried out all the same, and was followed by a heavy punishment: 70,000 Israelites died of the plague before the Lord relented and accepted burnt offerings as a token of David's repentance.

Taking a census thus came to be known as the sin of David, and was long regarded as best avoided. In 1634 Governor John Winthrop of the Massachusetts Bay Colony estimated the local population rather than counting it exactly, telling a correspondent: “David's example stickes somewhat with us.” And when a Census Bill was debated in Britain in 1753, Matthew Ridley, the member of Parliament (MP) for Newcastle, gave a speech saying that there was among the people “such a violent spirit of opposition to this Bill, that if it be passed into a law, there is a great reason to fear, they will in many places oppose the execution of it in riotous manner.”

But nobody needed David's dreadful example to persuade them that censuses were a bad idea. From the point of view of those being enumerated, nothing good could come of being counted. The usual reasons for wanting the numbers were war and taxes. From the sovereign's point of view, such information was crucial: the decision to go to war could be taken only once it was known how many men could be conscripted and how much money levied. So the results were highly sensitive, and an enemy country's numbers would be useful when deciding whether attacking it was prudent, and conquering it worthwhile. The results of a Swedish census in the mid-1700s appear to have been made a state secret because of such fears.

But at the same time men were becoming enamoured of numbers and taking to counting as a way of answering pressing questions of their own. Following the London plague of 1603, weekly Bills of Mortality began to be published, listing all the deaths in the city and, from 1629, their causes. According to John Graunt, whose 90-page book interpreting and drawing conclusions from these bills is generally regarded as the earliest statistical analysis, they were used by the rich to “judge of the necessity of their removall” and by tradesmen to “conjecture what doings they were like to have”. And in 1731 Benjamin Franklin published in the Pennsylvania Gazette, the newspaper he edited at the time, an account of all the ships that entered and left the big northern colonial ports, together with their destinations, so that the reader could “Make some Judgment of the different Share each Colony possesses of the several Branches of Trade”.

It was revolution that renewed the impetus for rulers to count their people. The American war of independence brought a new nation into being, and it was not only one that was made up of separate states, each keen to get full credit for its relative size, but also one whose population was on the move. In order to decide how many representatives each state should send to the new Congress, there was only one thing for it: their populations would have to be counted, and that count would have to be repeated regularly.

America's first census was carried out in 1790, and it was groundbreaking in many ways. It was the first to be mandated in any country's constitution. It was also the occasion for America's first presidential veto, exercised by George Washington on the advice of Thomas Jefferson, whom he had asked to examine the proposals for sharing out congressional seats between the states. Jefferson—a man so fond of enumeration that he once wrote to a friend that he had “ten and one-half grandchildren, and two and three-fourths great-grandchildren”, and that “these fractions will ere long become units”—criticised them for being unclear about how this “apportionment” was to be carried out. He advised Washington that a completely unambiguous method should be chosen and enshrined in legislation.

AFP They want to know what?

The fact that this thriving new nation counted its citizens without provoking divine retribution may have given courage to other Christian countries. Over the following decade Denmark, England, the Netherlands, Norway and Sweden all instigated regular censuses of their own.

People started finding the sorts of patterns in the resulting data—life expectancies, crime rates, causes of death, and the mix of religions and races—that are now part of our familiar mental furniture. In the 1800s, for instance, two French statisticians, André Michel Guerry and Adolphe Quetelet, analysed the tables of crimes against individuals and property that had recently started to be published. They were astonished by the hitherto-unsuspected regularities they found. Guerry was particularly struck by the fact that the method by which someone committed suicide could be predicted from his age. The author of an English commentary on his work described his findings thus: “The young hang themselves; arrived at a maturer age they usually blow out their brains; as they get old they recur again to the juvenile practice of suspension.”

Quetelet was equally amazed by the regularity with which the various types of crime were committed. “We can enumerate in advance”, he wrote, “how many individuals will stain their hands in the blood of their fellows, how many will be forgers, how many will be poisoners, almost as we can enumerate in advance the births and deaths that should occur.” Such regularities, he claimed, left no role for free will in human affairs. “Society prepares the crime”, he wrote in 1832, “and the guilty person is only the instrument.”

Opposition to this line of thinking came from Charles Dickens, who loathed all arguments based on numbers and averages, charging that they were used to legitimise indifference to other people's suffering. His strongest broadside against those who thought that counting people was a good way to answer social questions came in his novel “Hard Times”. When Tom, the hard-hearted Gradgrind's son, is found to be a thief, he uses his father's statistical determinism to shrug off responsibility. “So many people, out of so many, will be dishonest. I have heard you talk, a hundred times, of its being a law. How can I help laws? You have comforted others with such things, father. Comfort yourself!”

The future, though, belonged to those like another ardent social reformer, Dickens's near-contemporary, Florence Nightingale (see article). Best remembered for nursing wounded soldiers in the Crimean war, her sanitary reforms were based on meticulous records of hospital admissions, illnesses, treatments and outcomes. Rather than painting moving pen-portraits of soldiers left to rot on stinking, louse-ridden pallets in a hospital built on an open sewer—as Dickens would no doubt have done—she used death rates to campaign, successfully, for change.

Nowadays, a census is part of the standard equipment of a functioning state. In 1995 the UN called for all member nations to hold a census in the following decade. Yet counting people remains a sensitive business for two reasons, connected with the ambiguous character of government. Where government is oppressive, people want to keep out of censuses, lest information they provide is misused. Where government provides, people want to be in censuses, and to boost their numbers, in order to claim a larger share of the goodies.

Include me out

History offers good reason for worrying about the misuse of information. The Nazis used population records to round up Jews into concentration camps. As a result, Germans are still prickly about being counted. When in the 1980s their government added new questions to the census, there was a public outcry and the constitutional court struck it down on the grounds that it conflicted with a “fundamental right to informational self-determination”. Although the country is planning a census in 2011—its first since reunification—it will not be a full count, but only a sample. Respondents' surnames will be deleted as soon as possible and all data that could identify an individual will be erased once statisticians have finished with them. Questions on race and religion will not be included.

Getty Images

Fears that the data might be used for purposes other than the declared ones may have undermined China's most recent census in 2000. This involved 6m enumerators visiting around 350m households in just ten days. They asked some rather personal questions, such as “How much did you pay for your home?” and “How often do you wash?” But it was the standard ones about the number of residents in each household and their sex and age that provoked the most anxiety. The government wanted to find out whether the country's gender imbalance was primarily due to the abortion and infanticide of females, or whether many of the missing girls were in fact alive and being concealed. To encourage parents to register over-quota children, it reduced the penalties for anyone found to have flouted the one-child law. Some also contend that large numbers of peasants who migrated illegally to the big cities will have hidden from the enumerators, and that there may be as many as 100m uncounted Chinese on top of the 1.3 billion the census found.

It isn't just oppressive governments that misuse information. In early 2007 researchers found proof of what had long been suspected: that during the second world war the American census bureau had played a part in the internment of Japanese-Americans by passing some of their names and addresses to the secret service.

Other people's money

In autocracies, people try to keep out of censuses. In democracies, by contrast, they want to be in them, for censuses mean numbers, and numbers mean money and power. The American census, for example, determines how around $200 billion a year of federal funds is shared out, for everything from education and welfare to highways. Such rich pickings mean that censuses are well worth fighting over.

Although Jefferson ensured the American states could not squabble about the formula used for apportionment, he could not have predicted the partisan rows about how to deal with undercounting. No census counts everyone, and the uncounted are not drawn uniformly from all walks of life. The poor, the homeless, immigrants and ethnic minorities are missed more often. The 1990 census is thought to have missed one native American in eight.

Imaginechina

The statisticians' solution is to follow each census with a quality check, surveying representative areas to create a picture of those overlooked in the full count and correcting the figures accordingly. Perhaps unsurprisingly, in light of the profile of those most likely to be missed, Democrats find the intellectual arguments in favour of such adjustment more compelling than Republicans do. Before the census in 2000, the Supreme Court ruled that sampling-adjusted figures could not be used for apportioning congressional seats. But the row over whether they should be used to share out cash raged until 2001, when the census bureau finally declared the raw figures good enough to stand unaltered.

In Britain the 2001 census was corrected using such sampling techniques, but some areas still complain that they are being undercounted. In the decade between censuses, the national statistical office updates the figures with estimates of external and internal migration. Some towns with lots of foreigners are convinced that large chunks of their population are being overlooked, losing them millions of pounds of government money. The MP for Slough, a town to the west of London full of Poles, poetically told Parliament in January that the increasing “amount of shit that goes through our local sewers” was evidence that her constituency was being sold short.

Some groups are begging to be counted because they hope to prove their importance and increase their influence with government. Church leaders in Britain were gratified when the 2001 census, the first to ask about religion, found that 70% of the population identified themselves as Christian. They reckoned this was a large enough majority to justify their religion's special place in state-run education. Whether the figures bear the weight that has been put on them is, however, questionable. Church attendance figures suggest that few of these self-identified Christians attend services more than once a year, or indeed at all. And the irreverence with which some respondents treated the question can be judged by the 390,000 people—0.7% of the population—who answered it by claiming to be Jedi.

Some groups are begging to be counted to prove their importance and increase their influence

Dashed hopes of gaining a higher profile caused despondency among gay and lesbian groups when it was decided not to add a question about sexual orientation to Britain's next census, to be held in 2011. Government statisticians were keen, but they were stymied by the difficulties of phrasing a question that would neither offend people nor leave them in the dark about what was being asked. They were mindful of the reaction to a question on self-perceived sexual identity in a recent survey by the Metropolitan Police. The most common query it provoked from respondents was: “What's heterosexuality?”

That British gays wanted to stand up and be counted says much for national tolerance. It is hard to imagine the same happening in Nigeria. There, the dispute is about who will get the oil money. The country has not had an uncontested census since gaining its independence in 1960. Civil war and poorly trained enumerators have been formidable obstacles to a reliable count. The most recent census, in 2006, omitted questions about religion and tribe following demands from leaders in the largely Muslim north. Christians in the south, who believe they have been undercounted in the past, threatened a boycott unless the questions were asked. The census found 140m people: 75m in the oil-poor north and 65m in the revenue-poor south. Politicians in the north endorsed the figures; those in the south did not.

In India, the arguments are not about money, but about a different sort of resource: the jobs and university places handed out under the government's affirmative-action programme. Many dalits, or untouchables, have tried to escape the discrimination they face in Hinduism by converting to Christianity or Islam. But this means no longer being eligible for the programme—a restriction on religious freedom, say some, and indeed court challenges are wending their way through the system. Rather than being neutral in this dispute, the census form took sides by allowing respondents to indicate their caste as dalit only if they claimed to be Hindu, Sikh or Buddhist.

The shakier the state, the fiercer the rows about censuses, for numbers affect how power is distributed. In Iraqi Kurdistan, for instance, a census due to happen in 2007 was delayed. It was intended to correct figures distorted by Saddam Hussein's “Arabisation” programme, which forced many Kurds to leave and others to declare themselves Arab. If and when an Iraqi census happens, it will not only give a truer picture of the ethnic mix in a contested region, but will also have consequences for billions of dollars in oil revenues.

Lebanon has not held a census since 1932, when it counted the number of adherents to various religions in order to share out power under a system known as confessionalism. Since that time its demography has changed and the politically favoured Christians are now believed to be in a minority. Plenty of powerful people are keen to keep that quiet, so the prospects for a new official count are dim.

Counting can be even more dangerous than being counted. In 1936 Stalin told his officials that the following year's census would find a total population of 170m—a figure that took no account of his slaughter of millions in famines and purges. But the enumerators found only 162m people, and also revealed other unwelcome facts, including that nearly half the population of this avowedly atheist country was religious. So Stalin denounced the count as a “wrecker's census” and had the census takers either imprisoned or shot. A new count in 1939 came up with a similar total, but this time officials wisely classified the results and gave Stalin his figure of 170m.

That Stalin insisted on this charade is a backhanded testimony to the way counting introduces people to themselves. “The interest and significance of the census for the community lie in this,” wrote Leo Tolstoy of the Moscow census of 1882: “that it furnishes it with a mirror into which, willy nilly, the whole community, and each one of us, gaze.” The faces that look back can surprise us still.



1222-23 2007周六周日

周六

1400參加2007 K氏台灣青年人文與科學獎 送李2本時瑋的書

2006【大紀元12月24日報導】(中央社記者劉嘉韻台北二十四日電)由一位不願具名女士捐助的K氏台灣青年人文與科學獎,2006年得獎名單今天出爐, 人文獎得主包括紀錄片導演郭亮吟、紀錄片製作陳育菁,科學獎得主是台灣大學物理所博士後研究員林夏玉,每位得主可獲得新台幣五萬元獎金。

K氏台灣青年及科學獎頒獎典禮上午在台大校友會館舉行。K氏青年獎助計畫主持人、著名詩人李敏勇指出,這個獎項是由一名不願具名的K女士捐助,今年邁入第五年,獎項旨在鼓勵關懷台灣社會的青年,原本只設有人文獎,去年起增加了科學獎。

李敏勇說,這個獎項每年選在聖誕節前夕頒發,鼓勵得獎人在人文之路與科學之路的努力,以及兼具台灣信念與社會關懷的精神,今年共有三名得主,得獎人全部都是女性。

人文獎得主郭亮吟是紀錄片導演,曾參與多部跨國合作劇情片與紀錄片,作品「尋找1946消失的日本飛機」,「綠的海平線-台灣少年工的故事」分獲多項影展獎項,為影像台灣的歷史追尋留下見證。

人文獎另一名得主陳育菁長期擔任社會運動團體志工,參與台灣轉型正義相關事務,在「台灣民主化之路」紀錄片製作中,呈現文化志向與社會關懷。

科學獎得主林夏玉修習物理學,致力於材料、光學、顯微術研究,並投入科學史研究,深具台灣信念,在多項台灣物理學發展史研究計畫投入心力,顯現學術研究的執著與本土關懷精神。

今 年K氏台灣青年獎助計畫也頒發了一項特別獎。李敏勇說,去年K氏科學獎得主、台大畢業生孫嘉梁是腦性麻痺患者,卻具有高度進取心,考取教育部公費留學前往 美國攻讀數學博士學位,由於他身體不便,需父母陪同照料,因此計畫將於每年獎助二十萬元,一連五年共一百萬元,肯定孫嘉梁的努力。




無名K氏 獎學金鼓勵台灣青年
林依蓉
2004/05/19 第405期
台灣大部分的獎項、獎學金都凸顯出獎助者人名,以玆紀念,不過,「K氏台灣青年文學獎」的獎金提供者卻隱名為「K氏」,不禁令人感佩這份「為善不欲人知」的信念。

K氏台灣青年文學獎,是由一位K女士所贊助的獎助計畫,獎項設立的目的是鼓勵在學青年於人文領域的貢獻。此筆獎助經費,委由鄭南榕基金會董事長李敏勇管 理、審核及頒發,選拔小組每年主動發掘二名符合資格的在學學生,頒給獎座及五萬元獎助金。今年由成功大學歷史所博士生王昭文、中山醫學大學醫學系學生吳易 叡獲得。

事實上K氏台灣青年文學獎的前身是「台灣醫生人文獎」,為了鼓勵「經濟型」的醫生能多注重人文氣息的涵養,不要僅以賺錢為目標。在醫生人文獎執行多年後, 選拔小組認為,僅把頒獎範圍限於「醫學生」似乎略為狹隘,因此從去年起將獎項名稱改為K氏台灣青年文學獎,並且擴大鼓勵範圍,凡是用心關注台灣人文的大學 部、碩博士班學生,皆有得獎機會。

除了關心人文,K女士在今年更設立了「K氏台灣青年科學生獎學金」,頒發給成績優異但家境困苦的科學領域學生,提供一個月一萬、共二年的獎助學金,期望幫助台灣青年在學習之路上走得更順遂。(林依蓉)




王大哥
我現在在苗栗洪牙醫
前幾天你說環島 對我的挑戰太大
這兒元旦要去南庄
我連看日出的資格都沒--爬60度陡坡等等
所以等我回台灣要整備一番
我這回討論牙醫的護士
洪先生是留日的
他說近半世紀前日本即有專門牙科護士
台灣目前沒有
所以訓練起來費事
新進者只要求她們有無菌之觀念和懂得皮下注射
其他從頭教
為什麼台灣不搞專業護士
其中一原因是經濟利益
因為美國的可作清潔洗牙工作
這是健保給附的
洪醫師說 他們每月這方面收益近十萬
這是醫師公會的問題
我剛剛咬合作齒模失敗3次
其實搞不清處什麼是醫師之咬合要求
普通牙醫機會成本是一小時5000元
植牙者至少三萬
閒談到此 現在1236 醫師還在忙 我今早做一筆記

《杏林生涯雲和月》(台北:台灣商務 出版社 1990退休後77歲回憶作品 充滿風趣和智慧的作品
讀它可以了解他擅長的短歌與繪畫

他當時就認為各組織 (包括台灣大學醫院等)之"首長" 最重要的是要求"品質".....

他評鑑時注意到大部分的病歷資料都很不周全事隔20年之後 情況似乎沒多大改善我同洪牙醫談 他指出初診的資料最重要 不過現在健保局每人只給250元 而作好它起碼要花半鐘頭






SONY 火燒筆電 應該說是那一年?  以公開道歉為準嗎 是那年那月?  然後出現一個安全長 掌管品質 是這樣嗎?  安全長是何等層次? 請教 謝謝
SONY 火燒筆電 應該說是那一年? 2006  以公開道歉為準嗎 是那年那月?10月  然後出現一個品質-安全長 --全公司第一層 

這些請參考2007年3月或4月 "品質月刊 我在2006年12月14日之講稿 請參考

2007年12月21日 星期五

Sub-optimization

optimization

Quote from W. Edwards Deming:
Sub-optimization is when everyone is for himself. Optimization is when everyone is working to help the company.

主禱文(天主教稱天主經)

The Lord's Prayer,[1] also known as the Our Father or Pater noster is probably the best-known prayer in Christianity.

主禱文

维基百科,自由的百科全书

主禱文天主教天主經)是基督教最為人所知的禱文。據《聖經》記載,門徒請求耶穌指導禱告,耶穌便教導他們一個模範禱告。

主禱文記載於新約聖經馬太福音6章9至13節,為登山寶訓的一部分;另一篇相似的禱文記載於路加福音11章2至4節。而兩篇禱文的內容相似,卻不是一樣的。

主禱文

  • 和合本聖經譯本 (普遍使用的版本)
我們在天上的父,
願人都尊祢的名為聖,
願祢的國降臨,
願祢的旨意行在地上,
如同行在天上。
我們日用的飲食,
今日賜給我們,
免我們的債,
如同我們免了人的債,
不叫我們遇見試探,
救我們脫離兇惡,
因為國度、權柄、榮耀,全是祢的,
直到永遠。阿們
  • 現代中文譯本版本
我們在天上的父親:
願人都尊崇你的聖名;
願你在世上掌權;
願你的旨意實現在地上,如同實現在天上。
賜給我們今日所需的飲食。
饒恕我們對你的虧負,正如我們饒恕了虧負我們的人。
不要讓我們遭受承擔不起的考驗,
要救我們脫離那邪惡者的手。
因為國度、權柄、榮耀,全是祢的(這句是較晚的抄本才加入的,原文無此句)
我們在天上之父,
願人皆尊父名為聖,
願父國降臨,
願父旨意成就在地,
如同成就在天。
我們日用之飲食,
求父今日賜與我們。
又求饒恕我們之罪,
如我們饒恕得罪我們的人。
保佑我們不受誘惑;
拯救我們脫離凶惡。
因為國度、權柄、榮耀,
皆屬於父,永無窮盡。
阿們。
  • 文言文版本
我父在天,
願爾名聖,爾國臨格,
爾旨得成,在地若天。
所需之糧,今日賜我。
我免人負,求免我負。
俾勿我试,拯我出惡,
以國權榮,皆爾所有,
爰及世世,誠心所願。

天主經

天主教版本的主禱文稱為天主經,又稱七求經,禱文如下:

我們的天父
願祢的名受顯揚
願祢的國來臨
願祢的旨意奉行在人間
如同在天上
求祢今天賞給我們日用的食糧
求祢寬恕我們的罪過
如同我們寬恕別人一樣
不要讓我們陷於誘惑
但救我們免於凶惡。亞孟!

留意天主經沒有最後的兩句「因為國度、權柄、榮耀,全是祢的,直到永遠。」(到了教會第一世紀開始,教會禮儀就習慣以那兩句來結束)。 一般都會刻意加上這兩句,因為按《天主教教理》第2855號,這兩句與前三句:「願祢的名受顯揚,願祢的國來臨,願祢的旨意奉行在人間」重複。因此十六世紀以後,天主教不鼓勵在天主經內重複這兩句。只有在彌撒中會保留它們。在彌撒唸完天主經後,會唸《光榮頌》即「天下萬國,普世權威,一切榮耀,永歸於祢」。

拉丁原文為下,為方便起見,分行乃配合中文排列

Pater noster, qui es in caelis,
sanctificetur nomen tuum;
adveniat regnum tuum;
fiat voluntas tua,
sicut in caelo, et in terra.
Panem nostrum cotidianum da nobis hodie;
et dimitte nobis debita nostra,
sicut et nos dimittimus debitoribus nostris;
et ne nos inducas in tentationem;
sedlibera nos a malo.
Amen.

天主經曾經有文言文的翻譯版本:

在天我等父。
我等願爾名見聖。
爾國臨格。
爾旨承行於地如於天。
求今賜我等日用之糧。
而免我等債。
如我亦免負我等債者。
又不導我儕於誘感。
乃救我儕於凶惡。
亞孟。

另一版本(老一輩教友的台語禱詞)是:

在天我等父者,
我等願爾名見聖,
爾國臨格,
爾旨承行於地,如與天焉。
我等望爾,今日予我,
我日用糧,
爾免我債,
如我亦免負我債者,
又不我許陷於誘感,
乃救我於兇惡,
亞孟。




太陽下山,回頭看

前些日子,我去了敘利亞南部,因為那裡有一個小村落,村落裡仍然講阿拉美語,這是耶穌在世時所用的語言,我相信這裡一定可以找到一些與耶穌有關的事蹟。

果真,我在一座小教堂裡發現他們的彌撒用阿拉美語。我雖然不懂阿拉美語,但我知道彌撒是怎麼一回事,所以我可以知道現在在念什麼經文。當神父念《天主經》的時候,我幾乎感動得流下淚來,因為我知道耶穌當年就是這樣念的。

我望彌撒的教堂非常小,石頭砌起來的,在一個偏遠的山谷裡,四周只有幾戶人家,但是他們自稱這是歷史上最古的基督教堂。這座教堂有一個很好聽的名字,叫作 「小燈教堂」。為什麼叫作小燈教堂呢?神父說不出來,但是二千年來,這座教堂晚上必定點一盞燈,現在是用電燈了,過去用的是油燈,可以想見這座教堂必須有 人過幾小時就要去加油,因為燈是要亮一整夜的。為什麼要整夜點一盞小燈,神父又不知道,他說這是世世代代傳下來的傳統。

我在教堂裡四處張望,發現了一幅壁畫,這幅壁畫中,耶穌背著十字架往前走,有一個小男孩淚流滿面地拉著耶穌的衣服,他們好像在對話。畫下面有兩行字,我當然看不懂這些字的意義。神父替我翻譯,原來這兩行字是小男孩和耶穌的對話。

小男孩說:「耶穌不要走,你走了以後,誰會照顧我們窮小孩子?」耶穌說:「太陽下山的時候,回頭看!」

小男孩的問句,我可以明瞭,但耶穌的回答卻使我困惑不已。我當時的感覺是耶穌答非所問。

我問神父,這是什麼意思?他也不懂,但是他相信這一定是有意義的,所以這幅壁畫就永遠地被保存了下來。過幾年,他們總要修補一下。

我走出教堂,仍然想著這句話的意義。想來想去,想不通。天色已經昏暗,太陽快下山了。教堂建在一座小山上,山的一邊面對著海,一邊是一個很美,但很荒涼的 山谷。我有了一個衝動,要到山頂上去看日落,因為山不高,我一下子就走到了。也看到了太陽在海平面上慢慢消失的景象,當時我忽然有點害怕,因為我發現我是 在一個非常荒涼的地方,天黑了,我會不會完全迷路呢?

我想起了耶穌的話,「太陽下山的時候,回頭看。」我回過頭去,發現山谷中雖然沒有很多人家,但是家家戶戶都點起了燈,那所小燈教堂的燈也亮了。

我不害怕了。雖然太陽已經下山,但有這些人點燈,我就安全了。太陽將光和熱帶給了世界,但是太陽下山以後,仍然有一些小燈,用它們微弱的力量,帶給世界光和熱。

我終於懂了,耶穌在安慰這個窮小孩子,他可以放心,世界上一定會有一些善良的人,繼續做耶穌在世時所做的事:使這個世界有一些光明,有一些熱。那位壁畫中 的小男孩一定也有同樣的頓悟的,雖然他是一個沒有受過什麼教育的人,但他一定做了一個好人,盡量地幫助周遭的人。他也一定四處勸告朋友,大家都要像一盞 燈,無論燈光如何微弱,很多人都會靠這一盞小燈生活的。也許這一座小燈教堂就是他造的。

我離開了敘利亞,我不會忘記小燈教堂的。我們都應該扮演小燈的角色,至少要使我們周遭的人不再害怕黑暗,不再感到寒冷。

某醫院病患筆記 (W. Edwards Deming)



中華民國品質學會 (王晃三策劃)

醫療照護最佳運作模式 (吳欣怡博士)

大功告成

So Far, So Good.

吳欣怡博士問起 Dr. Deming一篇論文:


Dear Dr. Wu,

Congratulations for the very successful quality forum and a wonderful presentation.

I checked with the file and list a paper by Dr. Deming for your reference.


Some Notes on Management in a Hospital, Journal of the Society for Health Systems, Vol. 2, No.1, Spring, 1900.


In case you can not get it then I'll try to "find out" it and scan it for our reference.

Once again, wish you and your family a nice trip here. I hope we can meet soon or later and I can report back some of our accomplishments soon.


Best Regards,

Hanching Chung


譯按:這是戴明博士所謂的改善/改革的「外來」智慧之一例。

一家醫院是某醫療系統中的一個重要組成。在營運上有效率的系統中,作業人員了解他們的工作如何與該系統配合。每個人都自覺其重要,工作的同事們也都會感到自己是要角。

要使系統發揮最佳的效果,光憑苦幹與全力以赴還不夠。一系統必須善加經營。醫院的管理者對院內的許多事情知之甚詳。護士長也一樣。譬如說,護士長知道許多管理者看不到的事情。同樣的,任何工作其間的護士也如此。照顧住院病人的醫生會知道許多醫院的「獨家新聞」。院內病人會看出他人所未見的。

這些從不同角度得來的觀察,如果能公之於世,對醫療系統的管理或會有所助益。

下述筆記為某一喜觀察而心懷感恩的病人所作。它們顯示,護士們即使極為認真、努力,又具備特殊技能和知識,卻大多為(系統所)浪費掉了。護士們眼見她們的努力,大半都毫無成果,一定感到很喪氣。在這種情況下,身為護士如何感到有尊嚴、以職業為榮呢?

作者希望發表這些從病人觀點看醫院的筆記,能對醫療管理之改善稍有幫助。

某醫院病患筆記

Some Notes on Management in a Hospital, Journal of the Society for Health Systems, Vol. 2, No.1, Spring, 1900

2007年12月20日 星期四

永遠的危機 困境 *perpetual crisis

感謝二重村的朋友。

歲末。 郵局員工莫名其妙都戴上聖誕老公公式帽子。

捷運公館站前停一堆幾乎無人問津的往「市立第二殯儀館」之接泊公車。

昨天晚上媽從台大醫院的手術房出來。她局部麻醉。所以「所聞到」的手術房之種種聲音,多「不堪入耳」。兩位推床車的護士之一,聽到廣播,竟然衝去聽電話,讓車子傾斜而撞出;雖然另外一位道歉……

nursing station的護士和實習醫生都很忙……

醫療系統太複雜,所以必須分解研究:宏觀(全球、萬國、區域;專業);微觀(組織、個人:體驗、價值觀)

組織診斷要區分是根據研究的research-based change model 或是觀感。

紐約時報之文提到 “a public service” 公益服務







邀請函

敬邀 參加本學會於十二月二十一日(星期五)下午一時三十分起舉行之「醫療品質論壇」,並擔任與談人。

謹此致謝 蒞臨指導

中華民國品質學會 敬啟

學會地址:台北市羅斯福路二段75號10樓



紐約時報社論

Slowing the Rise in Health Costs
The good news is that many of the reforms analyzed by the Commonwealth Fund might improve the quality of health care delivered to Americans.

Editorial

Slowing the Rise in Health Costs

Published: December 20, 2007

With the disjointed American health care system in perpetual crisis, it is essential to find ways to slow the relentless rise in costs, without jeopardizing the quality of care. There is no single solution. But a broad range of reforms could combine to produce worthwhile savings.

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The Commonwealth Fund, a New York-based foundation, issued a report this week analyzing 15 policy options for the federal government that could reduce national spending on health care by as much as $1.5 trillion over 10 years — even after spending more than $200 billion to provide health coverage for all Americans.

The estimated savings amount to a modest 4.5 percent reduction from a projected $33 trillion in cumulative health care spending over the decade, and even these will be hard to achieve. Yet there is no choice but to try. The good news is that many of the reforms might actually improve the quality of care delivered to Americans.

The essential reform is to adopt technology that would allow information to be shared among all the doctors and institutions that care for a patient, lessening the chances of errors and duplication and encouraging better coordination of treatment. That would require an initial investment in technology, but, according to the study, could produce a cumulative savings of $88 billion over a decade. The Commonwealth Fund also lays out a reasonable approach to pay for that initial investment: a 1 percent charge on private insurance premiums and on the government’s Medicare expenditures.

The study’s biggest projected savings — $368 billion over 10 years — would come from establishing a public-private center to evaluate which treatments work best for which patients. The goal is to deter doctors from dispensing expensive treatments and drugs that don’t work, aren’t needed or are no better than cheaper alternatives. That is a superb idea and could produce big savings over time, although we are skeptical that the initial payback would be that high. Other savings are projected if the health system stops paying doctors for each service performed — an incentive for multiplying services — and instead pays for treating an entire episode of illness.

A few options that make good sense are sure to excite strong lobbying opposition. One would eliminate the unjustified subsidies granted to private Medicare plans. Another would allow the government to negotiate lower prescription drug prices for Medicare. More savings could be found if the government limited Medicare payments to doctors and hospitals in high-cost areas of the country, giving them the strongest possible incentive to adopt more efficient practices.

The Commonwealth Fund stresses that it is not advocating any of these reforms but is simply examining the potential of various options to slow the rate of growth in future health care expenditures. Unfortunately, the foundation failed to assess one controversial proposal — a Medicare-like insurance program to replace private insurance — that, by some estimates, could produce even bigger savings.

Yet the Commonwealth Fund has performed a public service by putting dollar estimates on the rather abstract proposals being discussed by many of the presidential candidates. If the United States hopes to bring health costs under control, it will need to start on these or other options as soon as possible.

2007年12月18日 星期二

The Heart of A Healthcare Quality Forum之筆記

The Heart of A Healthcare Quality Forum之筆記(by Hanching Chung



陳先生
周五我的handout 請參考 醫療保健品質論譠 HANDOUT from hanching chung有問題 請連絡 23650127

--
鍾 漢清
Hanching Chung (or HC/ hc)



........隨便讀一下美國這領域的書,就會感到必須皓首才可能窮點經。對於美國醫療系統的品管等( 不錯的)簡介,可以參考Juran's Quality Handbook第五版之Healthcare Services 章。我看其中約三分之一所根據的是 T. Noland 等應用Deming 的改善應用— 論文兩篇關於等待和延誤之研究—約 1996。文中說到RAND 70年代對於界定系統 —含顧客— 之貢獻。

另外,偶爾一揮手,可參考紐約時報的社論Editorial

America's Lagging Health Care System Published: November 1, 2007

和美國 W. Edwards Deming 協會:.

"Will the Utilization of Six Sigma, as a Tool in Healthcare Quality Management, Produce a Decrease in Medical and Medication Errors in the U.S. Healthcare System?" by S. Graser, Deming Scholar, Fordham University
(THE 12TH ANNUAL RESEARCH SEMINAR
13-14 February 2006 New York City)
。【注二】

【注一】

書名, 從體液論到醫學科學(From humors to medical science)作者, John Duffy. 青岛出版社,2000從體液論到醫學科學:美国医学的演進歷程

美國醫療界危機之(七本)書評

Does Health Care Have a Future?
by Joe Flower and David Knott

【注二】

我的網路資源2007

今年2007我在"中文品質百科" quality world 品質世界http://hcdeming.blogspot.com/ " 品質論壇"blogs都剪貼不少關於英國 -台灣等醫療品質之資料,讀者很容易可以找到。

QualityTaiwan 中文品質百科 Search Result :

(約)十分之一代表:

Taiwan IHA 台灣國際醫衛行動團隊

Changhua Health Care Quality Newsletter {彰化醫療品質通訊}

Quality Standards in Traditional Chinese Medicine 傳統中藥的品質標準

pay-for-performance 論質付費(英美醫療)

日英醫院與療效

NHS 諸醫院的病人死亡率比較:素質差的醫院病人死亡率明顯比素質優良的醫院高。

general practitioner英國醫生的品質評審: Quality and Outcomes Framework(QOF),

· Diagnosis-Related Group (DRG) 診斷關聯群

· double blind experiments 雙盲試驗

· emergencey measures

統計用語にいうsensitivityspecificity(Oct 5, 2002)

· Claude Bernard著《實驗醫學研究導論》北京:商務(1991)

· clinical trials 臨床試驗

Cancer centers release survival rates ( Japan)

日本走出第一步

有些醫院的病人末期的比率多 所以其5"預後率"看來比較差 所以有許多因素讓公布的數據無法反映所謂"醫療品質"

Cancer centers release survival rates

10/05/2007

in health care.with special moral duties

洗手沒?

Better: A Surgeon's Notes on Performance

Economic Scene

No. 1 Book, and It Offers Solutions


The typical book about current affairs is better at describing problems than solutions. But there is a nice surprise at the end of “Overtreated.” (If you find yourself wishing the book had fewer anecdotes, I’d suggest you skip to the end rather than putting it down.) In plain English, Ms. Brownlee lays out an agenda for reform that is usually confined to academic journals.

It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.

Other solutions would be more difficult — because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it’s the other guy who’s getting unnecessary treatment. These are the reasons that presidential candidates don’t focus on wasteful treatment.

But models for reform are out there. Hospitals that don’t use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance — that is, the health of their patients — and motivate employees to improve it.

As I’ve written before, there is nothing wrong with devoting a large chunk of our economy to medical care. Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century.

If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century.





行也blog 坐也blog 放下blog 何等自在:

管理學新生 http://hcnew.blogspot.com
台灣戴明圈: A Taiwanese Deming Circle
戴明顧問公司http://www.deming.com.tw/
simon university總部 http://mypaper.pchome.com.tw/news/2adigoxl
Books Birdviews 書海
People 人物 http://hcpeople.blogspot.com/
質與量
品質世界 quality world http://hcdeming.blogspot.com/
中文品質百科﹐http://qualitytaiwan

鍾教授您好:
衷心感謝提供寶貴資料
學會將會依王理事長的指示
進行相關資料彙編
屆時煩請不吝指導
順祝 聖誕快樂
新年如意

中華民國品質學會
陳玄岳

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