Physicians' Difficulties Due to Patient Safety Incidents in Korea: a Cross-Sectional Study

표지희,Eun Young Choi,이원,Seung Gyeong Jang,박영권,옥민수,Sang Il Lee 대한의학회 2020 Journal of Korean medical science Vol.35 No.17

Background: Medical professionals who experience patient safety incidents (PSIs) are vulnerable to emotional pain and other difficulties; such individuals are referred to as “second victims.” This study quantitatively examines the characteristics of physicians’ experiences of PSIs, along with the consequent difficulties and levels of post-traumatic stress disorder (PTSD), and post-traumatic embitterment disorder (PTED) regarding the events. Methods: An anonymous, self-report online survey was administered to physicians. This collected information regarding PSI characteristics (e.g., type, severity of harm) and impact (e.g., sleep disorder, consideration of career change), as well as participants' socio- demographic characteristics. Meanwhile, to quantitatively assess PSI impacts, PTSD and PTED scales were also administered. PSI characteristics and impacts were analyzed using frequency analysis, and the differing effects of indirect and direct PSI experience regarding consequent difficulties were analyzed using chi-square tests. Factors associated with PTSD and PTED scores were identified using linear regression. Results: Of 895 physicians, 24.6% and 24.0% experienced PSI-induced sleep disorder and eating disorder, respectively. Moreover, 38.9% reported being overly cautious in subsequent similar situations, and 12.6% had considered changing jobs or career. Sleep disorder was significantly more common among participants who directly experienced a PSI (32.8%) than among those with indirect experience (15.3%; P < 0.001). Linear regression showed that indirectly involved physicians had a lower mean PTSD score (by 8.44; 95% confidence interval, −12.28 to −4.60) than directly involved physicians. Conclusion: This study found that many physicians experience PSI-induced physical symptoms and behavioral responses, and that the severity of these symptoms varies depending on the type of incident and degree of harm involved. Our findings can provoke more active discussion regarding programs for supporting second victims, and can also encourage the establishing of a system for addressing PSIs that have already occurred, such as through disclosure of PSIs.

환자안전사건을 겪은 일반인들은 경험한 환자안전사건 소통하기에 만족할 수 있을까?

표지희,이원,장승경,최은영,옥민수,이상일 한국의료윤리학회 2019 한국의료윤리학회지 Vol.22 No.4

This study examines people’s experiences with the disclosure of patient safety incidents (DPSI), which is known to be effective in decreasing medical disputes and improving the relationships between patients and medical professionals. Data on people’s experiences with, and the impacts of, patient safety incidents were collected by means of an online survey of 201 individuals. Only 30.3% (n=61) of participants had experienced full DPSI. The study found that those who experienced patient safety incidents with permanent disability or death were significantly less likely to report expressions of sympathy and regret from the relevant medical professionals than those who experienced patient safety incidents with a lower level of harm (p=0.003). The percentage of participants who reported sleep disorders was 35.3% for “no disclosure”, 28.1% for “partial disclosure”, and 31.3% for “full disclosure” (p=0.673). The results of the survey indicate that those who experience patient safety incidents do not in general receive proper responses from the relevant medical professionals. This in turn suggests that detailed guidelines and training programs for DPSI are required and that psychological and other forms of support should be provided to patients and caregivers who experience patient safety incidents. 이번 연구에서는 환자안전사건을 겪은 일반인들을 대상으로 환자안전사건 소통하기의 경험 여부를 알아보고 그 경험에 따라 환자안전사건으로 인한 어려움의 호소에 차이가 있는지 살펴보았다. 온라인 설문조사를 실시하여 경험한 환자안전사건의 특성(위해의 정도 등), 경험한 환자안전사건으로 인한 영향(수면장애, 식이장애 등), 환자안전사건 소통하기 경험(구성 요소별 경험까지), 인구사회학적 요인(성별, 연령대 등) 등의 자료를 수집하였다. 환자안전사건을 경험한 일반인 총 201명이 설문에 응답하였으며 환자안전사건 소통하기의 구성 요소 중 5가지 이상을 경험한 참여자는 30.3% (61명)에 불과하였다. 즉, 70% 에 가까운 참여자들이 환자안전사건 소통하기 과정을 부분적으로 경험하였거나 소통하기를 전혀 경험하지 못한 것으로 드러났다. 영구적 장애 또는 사망한 환자안전사건을 경험한 연구 참여자는 이보다 위해가 작은 사건을 경험한 연구참여자에 비하여 의료진이 발생한 환자안전사건에 대한 공감 및 유감을 표명하는 경우가 통계적으로 유의하게 낮았다(p=0.003). 환자안전사건 소통하기를 경험하지 못한 집단에서 수면장애를 호소한 분율은 35.3%였으나 부분적 소통하기나 완전한 소통하기를 경험한 집단은 그 분율이 각각 28.1%, 31.3%이었다(p=0.673). 이번 설문조사를 통하여 환자안전사건을 경험한 많은 환자 및보호자들이 의료진들로부터 제대로 된 환자안전사건 대응을 받지 못하고 있음을 확인할 수 있었다. 환자안전사건 소통하기의 가이드라인을 마련하고 교육을 진행할 때 환자안전사건의 위해 정도를 고려한 세부적 지침과 사례별 교육 및 훈련이 필요할 것으로 판단된다. 더불어 환자안전사건 소통하기 수행과는 별도로 환자안전사건을 경험한 환자 및 그 보호자를 위한 심리적, 신체적 지원책도 함께 제공될 필요가 있다.

울산광역시민의 미충족 의료 및 의료기관 이용 경험 현황

표지희,옥민수 한국보건경제정책학회 2020 보건경제와 정책연구 Vol.26 No.2

울산시의 높은 연령표준화 사망률과 낮은 기대수명 및 건강수명은 낮은 건강수준을 대변한다. 이번 연구에서는 이를 해소하기 위한 기초자료를 마련하기 위하여 울산시민 대상 미충족 의료 경험, 보건의료기관 이용 시 다양한 의료의 질에 대한 만족도를 설문조사 방법을 통해 살펴보았다. 설문조사는 울산에 거주하는 20세 이상 성인 남녀 600명을 대상으로 실시되었다. 이 연구에서는 공공 및 민간보건의료기관의 이용 여부 및 횟수, 보건의료기관 유형별 5가지 측면에서의 이용 만족도, 보건의료기관 유형별 미충족 의료 경험 여부 및 그 이유를 살펴보았다. 그 결과 공공 및 민간보건의료기관을 이용한 경험이 있다고 응답한 연구 참여자들은 각각 37.3%, 82.0%이었다. 연구 참여자의 보건의료기관 유형별 만족도를 5가지 측면에서 살펴보았을 때, 공공 및 민간보건의료기관 모두 만족하였다는 응답이 4분의 3 이상을 나타내었다. 하지만, 공공보건의료기관의 경우 진료/의료 질 측면의 만족도가 상대적으로 낮았고(만족함 87.9%), 민간보건의료기관의 경우에는 진료/의료 비용 측면의 만족도가 상대적으로 낮았다(만족함 76.6%). 보건의료기관 유형별 미충족 의료 경험은 공공보건의료기관(6.7%)과 민간보건의료기관(5.3%)에서 6.0% 내외로 조사되었다. 이번 연구결과는 울산 지역 내 공공보건의료기관의 이용 확대 방안 마련, 미충족 의료 해소를 위한 취약대상 및 취약지 확인, 보건의료기관 만족도 모니터링을 위한 기저치 생성 등에 도움이 되리라 기대된다.

의료사고 1차 피해자의 삶의 경험에 대한 질적사례연구: 의료사고 피해 당사자와 피해 유가족의 경험을 중심으로

표지희 한국질적탐구학회 2018 한국질적탐구학회 학술대회 자료집 Vol.2018 No.1

의료사고 피해 유가족의 의료소송 경험에 대한 질적사례연구

표지희,한영주,옥민수 한국상담학회 2018 상담학연구 Vol.19 No.5

The purpose of this study is to comprehensively understand the experience in malpractice suits of bereaved family who suffered medical accident. Two bereaved families of the victims of the medical accident participated in this study. The data were collected and analyzed according to Stake (1995)'s qualitative case study method. A total seven upper categories were derived. Those are ‘Memory of the victims of the medical accidents’, ‘anger toward the medical staff affiliated with the medical accident’, ‘lonely struggle for the medical lawsuits’, ‘distrust of medical law-related judicial world’, ‘nevertheless standing up for the medical lawsuits’, ‘necessity of institutional improvement for resolving medical accident’, ‘searching for new meaning after the medical accidents’. The results of this study are as follows: “In - case analysis” that independently explains the specific experiences experienced by each participant in the process of litigation after the medical accident, and “Inter - case analysis” summarizing by themes the meaning of their common experiences. Participants were exposed to secondary psychological distress in a special process of medical litigation as well as psychological distress in the occurrence of a medical accident. The necessity to develop counseling manuals for their specific experiences and for policy efforts that can be applied in the field of psychological counseling were discussed. 이 연구의 목적은 의료사고 피해 유가족이 의료사고 발생 후 의료소송을 진행하며 겪는 경험을 종합적으로 이해하기 위함이다. 의료사고 피해 유가족 2인이 연구에 참여하였으며, Stake(1995)의 질적사례연구방법에 따라 자료의 수집 및 분석, 해석을 진행하였다. 분석 결과, 의료사고 피해 유가족들의 경험은 ‘의료사고 피해자에 대한 아픈 기억’, ‘의료사고 관련 의료진에 대한 분노’, ‘의료소송을 위해 외롭게 고군분투 함’, ‘의료소송 관련 법조계에 대한 불신’, ‘그럼에도 불구하고 의료소송에 맞섬’, ‘의료사고 해결을 위한 제도적 개선의 필요성’, ‘의료사고 이후 새로운 의미를 찾아감’이라는 상위범주로 도출되었다. 연구결과는 각 참여자가 의료사고 발생 후부터 소송을 하는 과정에서 겪게 되는 특정 경험들을 독립적으로 풀어낸 ‘사례 내 분석’과 그들의 공통 경험이 갖는 의미를 주제별로 정리한 ‘사례 간 분석’으로 제시하였다. 참여자들은 의료사고 발생에 대한 심리적 고통뿐만 아니라 의료소송이라는 특수한 과정에서 2차적인 심리적 고통에 노출되고 있었다. 이들의 특수한 경험에 적합한 상담 매뉴얼을 구축하고 심리상담 현장에서 실행할 수 있는 정책적 노력의 필요성을 논의하였다.

입원 시 상병의 수집 및 활용에 관한 보건의료정보관리사의 관점: 질적 연구

표지희,최은영,오혜미,이원,김주영,옥민수,김소윤,이상일,Pyo, Jee-Hee,Choi, Eun-Young,Oh, Hae-Mi,Lee, Won,Kim, Ju-Young,Ock, Min-Su,Kim, So-Yoon,Lee, Sang-Il 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.1

Purpose: This qualitative study was conducted to examine the current status and problems concerning the collection of present on admission (POA) indicators and determine how to use these indicators for evaluating the quality of care and degree of patient safety. Methods: A total of 11 health information managers were divided into two groups according to the size of their hospitals. Two focus group discussions (FGDs) were conducted, one for each group, which followed a pre-developed semi-structured guideline. The verbatim transcriptions of the FGDs were analyzed. Results: The majority of participants were concerned about entering POA flags honestly because they did not know how future POA indicators would be used. In particular, for some participants, POA N was a burden that could imply a signal of mismanagement within the medical institution. In addition, the lack of awareness and indifference of physicians regarding POA indicators were some of the difficulties for POA flag entry. Although medical institutions are making efforts to improve the accuracy of POA flagging, many participants mentioned the need to develop real case-oriented POA entry guidelines to improve the accuracy of POA flagging. Conclusion: To increase the validity of POA indicators, it is necessary to increase the level of awareness of POA indicators in physicians and other medical professionals. Furthermore, efforts related to POA indicators by individual medical institutions need to be reflected in the process evaluation.

아파트 청소노동자의 건강지원사업 참여 경험

표지희,이미나,옥민수,양동석,박정선,김양호,박기옥 한국보건의료기술평가학회 2019 보건의료기술평가 Vol.7 No.1

Objectives: We conducted focus group discussions on cleaning workers who have participated as health leaders in vulnerable workers’ health promotion program in order to determine their experiences and perceptions as health leaders. Methods: A total of six cleaning workers participated in the focus group discussions. We performed the focus group discussions in accordance with the semi-structured guideline developed through the reviews of major prior studies and researchers’ discussions. The contents of the discussion and the notes recorded by the researchers were analyzed using content analysis. Results: A total of 103 codes were categorized into the categories as follows: “Health status of cleaner workers,” “A positive impression of the health promotion program,” “Experiences participating in the health promotion program,” and “Improvement of health promotion program.” Participants persuaded their colleagues to participate program. However, participants’ perception of the leader was lacking. They wanted a variety of health education and hoped that the program would run for longer. They also noted that the health promotion program should be applied to other apartment workers and should be persuaded with the effects of the program. Conclusion: This study could reveal the health management status of the cleaning workers, and it could be understood the implications and direction when the health promotion program was carried out for the cleaning workers. However, it will be necessary to educate the participants to recognize their role as health leaders, to evaluate them, and then to improve the deficiencies and carry out the program.

환자안전사건으로 인한 제1의 피해자 심리사회적 지원 프로그램 개발을 위한 유사 프로그램 검토

표지희,최은영,이원,장승경,옥민수,Pyo, Jeehee,Choi, Eun Young,Lee, Won,Jang, Seung Gyeong,Ock, Minsu 한국의료질향상학회 2021 한국의료질향상학회지 Vol.27 No.1

Purpose:In this study, we reviewed existing victim support programs implemented in Korea to aid in the development of psychosocial support programs for patients and guardians who have experienced patient safety incidents. Methods: We reviewed similar programs: a support program for suicide survivors operated by the Korea Psychological Autopsy Center (Korea Foundation for Suicide Prevention), a family harmony program for workers in industrial accidents operated by the National Center for Forest Therapy, and the support services for crime victims provided by the Korean Crime Victims Support Association. We reviewed the contents of each website and conducted interviews with key personnel from each institution. Results: The support program for families who have experienced suicide was developed based on the suicide prevention project at the Central Psychological Autopsy Center. The family harmony program for workers who suffered industrial accidents is operated by the National Center for Forest Therapy at the behest of the Korean Workers' Compensation and Welfare Service. The Korean Crime Victims Support Association was established by the Ministry of Justice in accordance with the Crime Victim Protection Act and provides support to victims of crime. Each program was designed and implemented considering the objectives and goals, defining their recruitment plans as well as the selection criteria for their participants, and creating quality content that adequately addressed the struggles of their participants. Conclusion: The summarization of the various types of victim support programs in this study can be helpful in the future development of psychosocial support programs for victims of patient safety incidents.

병의원 금연치료프로그램 참여자의 금연 경험: 질적 연구

표지희,옥민수,이재욱,한영주,조민우,이정아 한국보건행정학회 2017 보건행정학회지 Vol.27 No.4

Background: The objectives of this study were to identify the reasons of quitting smoking, to determine the factors that make it difficult or helpful to maintain smoking cessation and to confirm the changes after the smoking cessation. Methods: This study was conducted an in-depth interview with people who participated in the smoking cessation treatment program. There were 10 participants and they were interviewed thoroughly for 14 times. Using the directed content analysis, we analyzed the transcript which was written by recording the interview and the researchers’ note. Results: The results of this study are summarized as ‘the experience while at the verge of smoking cessation and stepping over the verge of smoking cessation,' ‘the changing experience due to smoking cessation,’ and ‘maintaining the changes through overcoming re-smoking.' The smoking cessation treatment program induced the smokers to quit smoking. Participants mentioned drinking alcohol was the major obstacle to maintain smoking cessation. Also, they noted that the money and the time that were already spent to quit smoking helped their smoking cessation as well as the social relations which helped to prevent re-smoking. Participants felt well-cared through the smoking cessation treatment program and that it helped them to maintain smoking cessation. Conclusion: Smoking cessation treatment program has a positive effect on the smoking cessation trial and maintenance. In order for smokers to overcome re-smoking, educations regarding drinking problem, formation of supportive social relationship, and the applications for smoking cessation will be beneficial.

일반인 대상 환자안전 교육을 통한 환자안전 및 환자 참여에 대한 인식 증진: 예비 연구

표지희 ( Jeehee Pyo ),이원 ( Won Lee ),최은영 ( Eun Young Choi ),장승경 ( Seung Gyeong Jang ),옥민수 ( Minsu Ock ),이상일 ( Sang-il Lee ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적: 이 연구의 목적은 환자의 자기 보호 행동에 대한 인식과 환자 안전에 대한 의사 결정 참여를 확인하고 환자 안전 교육의 효과를 평가하는 것이다. 연구방법: 울산지역 퇴직자 지원센터 내 일반인을 대상으로 환자안전 교육을 진행하였다. 참가자들을 대상으로 교육 전후 환자 참여에 대한 인식을 알아보기 위해 자가기입 설문지를 실시하였다. 환자안전 교육의 효과를 평가하기 위하여 교육 전후 설문 응답에 대하여 Wilcoxon signed-rank test를 수행하였다. 연구결과: 총 25명의 일반인을 대상으로 교육한 결과, 통계적으로 유의하지 않은 결과도 있었지만 환자안전 교육은 전반적으로 환자안전 및 환자 참여에 대한 인식을 높일 수 있는 것으로 나타났다. 특히, 의료기관 인증 여부에 따른 의료기관 선택 의향, 의료기관 방문 시 보호자 동반 의향, 검사나 치료에 대한 환자 의견 반영 의향, 감염 및 낙상 관련 예방 활동에 대한 참여 의향에 있어 교육 전후 통계적으로 유의한 변화가 나타났다. 결론: 이 연구는 우리나라에서 처음으로 일반인 대상으로 환자안전 교육을 시행하였다는 측면에서 큰 의의가 있다. 더불어 이번 연구에서 개발된 환자안전 교육안을 참고로 하여 우리나라에서도 특정 유형의 환자안전사건들을 예방하기 위한 좀 더 자세한 교육안도 개발할 수 있을 것이다. 하지만 이 연구는 여러 선행 연구들에서 활용하고 있는 환자 참여 촉진 중재들이 낮은 수준의 단계에 머물러 있다는 제한점이 있기 때문에 후속 연구에서는 실제 임상 현장에서 적용해야 하는, 더 높은 수준의 환자 참여 중재 개발하고 활용해보는 것이 필요할 것이다. Objective: The purpose of this study was to identify the perception of patient’s self-protection behaviors and patient engagement in decision making for patient safety and to evaluate the effectiveness of patient safety education. Methods: Patient safety education was conducted in the Ulsan retirement support center. Participants completed a questionnaire to evaluate the perception of patient safety before and after the education. The Wilcoxon signed rank test was performed on the patient safety questionnaire response to compare the perceptions before and after the education. Results: A total of 25 people participated in this study. Although there were some statistically insignificant results, it was found that overall patient awareness of safety and patient engagement could be improved. Particularly, patient safety education led to statistically significant difference in pre and post educating in the tendency to choose medical institutions according to whether they are certified by medical institutions, intention to accompany guardians when visiting medical institutions, intention to reflect patient's opinion on test or treatment, intention to participate in preventive activities related to infections, and to participate in fall prevention activities. Conclusion: In the future, the researchers should develop and utilize higher level patient engagement intervention in the actual clinical field.