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1 19

2 Donabedian a s d a s d f a Avedis Donabedian, Quality Improvement through Monitoring Health Care s

3 3 JCAHO JCAHO JCAHO JCAHO a JCAHO The Joint Commission on Accreditation of Healthcare Organization JCAHO JCAHO JCAHO JCAHO500 JCAHO 25 JCAHO Flexner Reports Ernest Codman end result system of hospital standardization 1913 Franklin Mrtin Codman American College Surgeons -ACS Minimum Standard for Hospital JCAHO JCAH The Joint Commission on Accreditation of Hospital JCAH 1964 JCAH 1965 JCAH d f 1998 The Joint Commission on Accreditation of Healthcare Organization http // 21

4 JCAH 1987 JCAH JCAHO The Joint Commission on Accreditation of Healthcare Organization 1988 Indicator Measurement System IMSystem outcome ORXY s 1987 JCAH JCAHO AMH Accreditation Manual for Hospital JCAHO HMO JCAH JCAHO JCAHO KFOA Kings Fund Organization Audit HAP Hospital Accreditation Programs g -JCAHO Vol.18 No

5 ACHSA Australian Council on Health Services Accreditation 6 7 a JCAHO s h Ellie Scrivens, Accreditation : Protecting the Professional or the Consumer?, Open University Press,1995 j Charlotte Williamson, Whose Standards? : Consumer and professional standards in Health Care, Open University Press,

6 24 A B A B A B k

7 25 d 9 l 1998

8 Clinical Indicator Clinical Indicator 10 Clinical Indicator 11 a Decision Science Evidence-Based Medicine Decision Science Evidence-Based Medicine Sackett Evidence-Based Medicine

9 2 Evidence-Based Medicine Clinical Decision Science 12 medical freedom s medical malpractice defensive medicine Evidence-Based Medicine

10 - Facilitation Openended question Direct questionssupportempathy SilenceConfrontationValidation Recapitulation d 15 EBM evidence-based medicine f 3 Barbara Fadem, Behavioral Science 2nd edition, Williams & Wilkins

11 No

12 compliance

13 a

14 WHO s JCAHO Patient s Perspective JCAHO JCAHO 1995 Patient-Focused Functions patient Rights and Organizational Ethics Assessment of Patients Care of Patients Education Continuum of Care input input needsexpectations Joint Commission, Understanding The Patient s Perspective : A Tool for Improving Performance, Joint Commission on Accreditation of Healthcare Organizations,

15 input Focus Groups d f 4 A,B

16 g 1 Ver

17 Clinical indicator

18

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20 a s

21 d Albert R. Jonsen, Mark Siegler, William J. Winslade Cavin P. Leeman, John C. Fletcher, Edward M. Spencer and Sigrid Fry-Revere, Quality Control for Hospitals Clinical Ethics Services Proposed standards, Cambridge Quarterly of Healthcare Ethics Volume 6, Number 3, Winter 1997, David C. Thomasma, Models of the Doctor-Patient Relationship and the Ethics Committee, Cambridge Quarterly of Healthcare Ethics Volume3, Number 1, Winter 1994, Jay Katz, The Silent World of Doctor and Patient, The Free Press, 1984, Kaplan and Sadock s Synopsis of Psychiatry - Behavioral Sciences Clinical Psychiatry, Williams & Wilkins Krakauer Henry, Evaluating the Effectiveness of Hospital Care, American Journal of Public Health, 1997 Volume

22 JCAHO No NHK Tel Fax

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