哈尔滨市医务人员患者安全文化认知状况调查

目的对医务人员患者安全文化认知状况进行调研,为提升其患者安全文化认知水平提供参考。方法对哈尔滨市4所三级公立医院372名医务人员发放中文版医院患者安全文化调查问卷（HSOPSC）。所得数据利用EpiData 3.1软件及SPSS 22.0软件进行整理分析。结果72.58%的医务人员在过去12个月内从未上报不良事件。“组织学习与改进”“科室内团结合作”正性应答率较高。待改进维度为“事件报告频率”“人力资源配置”“对差错的非惩罚性反应”。结论医疗机构需提升医务人员患者安全文化认知,营造正向的患者安全文化氛围,以保障患者安全目标的实现。     

新建综合性医院医护人员患者安全文化研究

目的了解某新建综合性医院医护人员患者安全文化现状,寻找薄弱环节和潜在隐患,为患者安全文化水平持续改进与不断提升提供参考依据。方法采用美国医疗服务质量和研究组织通行的患者安全问卷调查法,计算正性回答率,获得该医院患者安全文化数据,和AHRQ同类医院正性反应率进行比较。结果该医院部门/区域安全等级评分正性反应率为75.5%。差错的反馈和交流、组织文化-不断改善、科室内部团队合作3个维度为患者安全优势领域。对差错的非惩罚性处理、人员配备、不良事件上报频率、科室间团队合作4个维度,为患者安全待改进领域;正性反应率最低的维度及与AHRQ差值最大的维度差错的非惩罚性处理、不良事件报告频率,提示为制约新建医院患者安全文化建设的关键环节及影响因素。结论建立公正文化,可促进不良事件上报,提升患者安全水平。     

陕西省6所三级医院患者安全文化现状及影响因素研究

目的了解陕西省三级医院患者安全文化现状,分析影响因素,为推动医院文化建设、实现医院安全管理提供参考。方法于2018年7月-9月向陕西省6所三级医院的医务人员发放问卷进行横断面调查,运用SPSS 22.0软件对所获数据进行统计分析。结果调查医务人员共计1 065名。患者安全文化总体评分为（3.74±0.41）分,83.00%的医务人员认为患者安全等级“非常好”或“很好”。患者安全等级的影响因素有性别、最高学历、用工形式、参与6S培训（P＜0.05）。对错误的反馈与交流、医院交接班与转科程序、医院管理支持、对患者安全的全面理解和医院各部门之间的协作等维度与患者安全等级呈正相关（P＜0.05）。结论参与调查的医院患者安全文化总体水平中等偏上。医院应积极使用质量管理工具,针对不同人员采用个性化措施,加大管理支持力度,重视差错事件的持续改进,以不断提升患者安全管理水平。     

杭州市基层医务人员卫生应急能力现状及影响因素分析

  目的  调查杭州市基层医务人员卫生应急知识水平及卫生应急能力现状，了解医务人员卫生应急能力的影响因素，为提高医务人员在突发公共卫生事件中的应急救援能力提供具有针对性的建议。
  方法  采用修订后的突发公共卫生事件应急知识和应急能力问卷，对杭州市8家社区卫生服务中心417名医务人员进行调查，并从人口学因素和卫生应急知识维度对基层医务人员卫生应急能力的影响因素进行多重线性回归分析。
  结果  杭州市基层医务人员卫生应急能力各维度评分从高到低排列依次为:急救能力（3.91±0.71）分、综合能力（3.87±0.64）分、应急知识学习能力（3.73±0.70）分。多重线性回归分析显示:和无职称人员相比，高级职称人员应急能力得分提高0.216分；相比未参加过卫生应急培训者，参加过卫生应急培训的基层医务人员的得分提高0.186分；相比未经历过应急救援活动者，经历过应急救援活动者得分增加0.177分；相比单位没有完整应急预案者，单位有完整应急预案的基层医务人员得分提高0.192分（P < 0.01）。应急知识维度中，医务人员“重大传染病的特点和应对措施”维度得分每增加1分，应急能力得分增加0.475分；“法律责任”维度得分每增加1分，应急能力得分增加0.136分（P < 0.001）。
  结论  杭州市基层医务人员卫生应急能力处于中等略偏上水平，应加强针对基层医务人员的卫生应急培训，提高基层医务人员卫生应急知识，完善基层医疗卫生机构应急预案建设，强化应急演练，从而进一步提高基层医务人员卫生应急能力水平。
     

员工对患者安全文化认知的现状调研

目的 了解某医院患者安全文化现状,为持续改善医疗质量提供依据。方法 对全院员工发放中文版医院患者安全文化调查表（HSOPSC）,计算量表各维度及各条目的积极反应率。结果 共1 208名员工参与调查,组织的学习与持续改进、科室内团队合作、对医院安全的总体评价、管理者在促进患者安全方面的意愿和行动、管理者对患者安全的支持、交接班和转科等维度积极反应率均大于75%,为优势区域;人员配置、对错误的非惩罚性反应、沟通开放程度、不良事件报告频率等维度积极反应率均小于50%,为待改进区域。不同职称、学历、下班延误时间、年龄、岗位、与患者直接接触等因素对医院患者安全文化总分有显著影响。结论 该院员工对患者安全文化认知现状较好,但在人员配置等方面需继续改进。     

患者安全调查分析与改进

利用AHRQ患者安全调查问卷对医院当前患者安全现状进行调研,发现“对过失/差错的无责反馈”“不良事件上报频率”“人员配置”是患者安全的主要薄弱环节,针对性制定改善措施并执行,无责反馈、人员配置有所改善,但不良事件上报频率改善不明显。利用患者安全测量工具可以发现安全管理的薄弱环节,但也应针对调查结果进行辩证分析。     

The financial viability of rural primary health care centers.

Primary health care centers have been proposed to meet the health care needs of rural America. Some centers become financially "self-sufficient", receiving their entire budgets from direct patient or third-party payments; others shut down when external funding is withdrawn. An explanation for this difference is important, because funding agencies may not wish to subsidize centers whose financial futures appear bleak. This study identifies the correlates of financial self-sufficiency. A survey conducted in late 1976 or 164 rural clinics provided 101 usable responses. Multiple regression analysis of the data shows that the longer a center has been in operation, the more self-sufficient it will become. Hospital control of the center and provision of laboratory tests increase self-sufficiency; outreach services and nonprofit status reduce it. Two variables related to financial self-sufficiency are separately examined. Clinics with a faster growth rate of patient visits are more self-sufficient, and smaller clinics tend to grow faster. More self-sufficient clinics experience less difficulty in keeping professional staff. The presence of a state Area Health Education Center (AHEC) program also eases the problem of staff retention.     

Advancing measurement of patient safety culture

Objective. To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement.
Data Source. Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents.
Study Design. A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data.
Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement.
Principal Findings. The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety ( α =0.88) and Unit leadership for safety ( α =0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions.
Conclusions. The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.     

第二受害者的经验与支持调查:以某精神专科医院护士为例

目的调查患者安全事件中精神专科医院护士作为第二受害者的经验与支持现状，并分析影响因素。方法2020年9月便利抽取北京市某三甲精神专科医院的280名护士进行问卷调查，采用单因素方差分析、多元线性回归分析方法分析影响因素。结果精神专科医院护士第二受害者负性体验报告率较高，经验与支持得分较高的维度是“心理痛苦”和“离职倾向”。不同年龄段、不同工作年限、经历患者安全事件、直接经历次数不同的护士群体在经验与支持量表总分上有统计学差异（P＜0.05）；直接和间接经历患者安全事件是精神专科医院护士第二受害者经验与支持水平和离职倾向的共同影响因素；年龄＞45岁是精神专科医院护士第二受害者经验与支持水平和缺勤的共同影响因素。结论精神专科医院管理者应重视护士第二受害者的身心健康，建立支持型的安全文化和相应支持性项目，以确保其安全。     

An evaluation of community health center adoption of online health information

Health care providers and patients in community health centers often lack access to online scientific and patient education resources. These resources can improve medical decision making and promote communication between provider and patient. In 2000, a community health information program, Partners for Health Information, provided 10 community health centers in Washington, D.C. with computers, training, and consumer health resources, supplemented with visits to coach patients and staff in their use. The purpose of this study is to assess the adoption of the use of online health information among staff in seven of these health centers. The methods of this evaluation were designed to measure frequency of patient referral by health center staff to online health information and to describe providers' perceptions of the barriers and enablers to using online resources. Recommendations made by respondents can be used to modify the Partners program and guide the development of other similar programs.     

Effect of work and organizational characteristics on workers in call centers: longitudinal study in an information service company]

To investigate the effect of work and organizational characteristics on workers' health status, with job dissatisfaction and intentions to leave as "organizational health", we conducted a longitudinal study using a questionnaire survey in call centers of an information service company from July to August in 2001 and 2002. The response rates were 96.2% and 92.0%, respectively. For the statistical analysis, the completed data of 296 technical support staff, which was more than 80% of the data, was used. We identified seven subscales composed of 29 items of work and organizational characteristics as scales of "organizational characteristics" and "work and workplace characteristics". The results of hierarchical multiple regression analysis showed quantitative and qualitative job-overload influenced psychological health status and poor supervisor support influenced all outcome variables. Moreover, "organizational characteristics" influenced cumulative fatigue and job dissatisfaction, showing an indirect effect with poor supervisor support and coworker support. This study suggests that measures of work and organizational characteristics are useful interventions for "organizational health".     

Bronson Methodist Hospital: journey to excellence in quality and safety

BACKGROUND: Bronson Healthcare Group, a 343-bed not-for-profit health care system serving all of southwest Michigan and northern Indiana, has as its flagship Bronson Methodist Hospital, the recipient of the 2005 Malcolm Baldrige National Quality Award. OVERALL APPROACH TO QUALITY AND SAFETY: The Baldrige criteria were used to formalize Bronson's approach to performance excellence. The strategic plan is condensed and communicated via a "Plan for Excellence" focused on three strategies: clinical excellence, customer and service excellence, and corporate effectiveness. ADDRESSING THE INSTITUTE OF MEDICINE (IOM) QUALITY AIMS: Initiatives include clinical scene investigation (a system for reporting and investigating sentinel and atypical events), a strategy for educating staff in the Situation-Background-Assessment-Recommendations (SBAR) communication technique, and mandatory influenza immunization for health care staff (safety), patient health literacy needs and a health information center (patient centeredness); methods to reduce bloodstream and ventilator-acquired pneumonia infections (effectiveness); a physician portal for access to forms, test results, and patient information (efficiency); restaurant-style pagers for patients and families while waiting (timeliness); and community outreach (equity). CHALLENGES AND LESSONS LEARNED: Bronson's journey to excellence continues with more accountability for hand-off communication and teamwork, enhancing a non-punitive environment for patient safety reporting, and further incorporating patient and family involvement.     

Breastfeeding promotion, protection, and support in primary health care in the State of Rio de Janeiro, Brazil: a case of evidence-based public health policy

This article evaluates a policy for breastfeeding promotion, protection, and support in primary health care units in Rio de Janeiro State, Brazil, analyzing the assumptions, interventions, and results based on a log-frame model. A systematic review sought to identify effective procedures and strategies for extending breastfeeding duration, constituting the basis for creating "Ten Steps" in the "Breastfeeding-Friendly Primary Care Initiative" launched in Rio de Janeiro State in 1999. A corresponding evaluation method was developed and applied to verify the performance of 24 primary health care units from different parts of the State. A direct association was found between the practical implementation of these steps and prevalence of exclusive breastfeeding, as well as with mothers' satisfaction. An analysis of meanings ascribed by pregnant women and mothers to the support provided for breastfeeding identified five categories: "no support", "doubtful support", "encouragement", "guidance", and "partnership". The evaluation model allowed staff at the health care units to recognize opportunities for improving the program, in order to reverse the current low prevalence of exclusive breastfeeding.     

国外如何处理医患纠纷

  目的  了解中医系统医院（以下简称中医医院）医务人员患者安全文化现状及其影响因素,为改善患者安全文化提供参考。  方法  采用方便抽样的方法,对1 000名来自4所三级甲等中医医院及3所二级甲等中医医院的医务人员进行患者安全文化问卷调查,分析医务人员的患者安全文化水平。  结果  调查共收回有效问卷947份,其中男性318人（33.58 % ）,女性629人（66.42 % ）;二级医院513人（54.17 % ）,三级医院434人（45.83 % ）;上海市中医系统医院医务人员患者安全文化总体状况良好,得分为（3.49 ± 0.38）分;多元线性回归模型分析结果显示,按照影响大小排序依次为：科室（特殊科室）（β = – 0.176）、职业（护士）（β = – 0.123）、工龄 < 3年（β = – 0.111）、医院等级（β = 0.093）,其中医院等级与得分呈正相关,工龄越长的医务人员其对患者安全文化的认知越差,与其余因素呈负相关。  结论  中医系统医院的安全文化理念处于一个良好的水平,并受诸多因素的影响,医院有关建立安全文化的措施仍然有待提高。     

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.     

患者安全目标与评价

患者安全应包括技术安全、管理安全和心理安全三个方面，依据是卫生法律、法规、规范、规程、常规和制度。目前在各级各类医疗机构还存在不少隐患，主要是基础管理和医疗服务不到位。各单位可以参考中国医院协会以及江苏省医院协会已经制发的患者安全目标的框架体系，制订长期奋斗强标和近期阶段性目标以及年度具体指标，落实患者安全责任。积极参与和适应医改新形势，增强职工“患者安全”意识，培育医院“患者安全”文化，开展患者安全目标评价，创新患者安全的环节和预警管理，加强护理工作，减少护理安全隐患，医患携手，共同维护患者安全。     

ISO 9001国际标准与医院管理评价指南整合的实践与体会

对ISO9001系列国际标准与医院管理评价指南进行比较，分析两者的基本内容特点，将两套标准整合为“一体化标准体系（IMS）”。有利于借鉴ISO 9001认证的经验。加强医院质量管理，强调医院管理重点在：提高质量与效益：提高医疗实践的安全意识。制定和执行保证患者安全的核心制度和操作规范，持续监测和改进“医疗实践流程”并教育职工如何实现医院质量目标而作出贡献。     

ARHP launches Depo-Provera education program

The Association of Reproductive Health Professionals (ARHP) has available a multimedia educational program informing physicians, nurse practitioners, clinical staff, and patients about Depo-Provera. It is called "New Developments in Contraception: Depo-Provera". The Upjohn company partially funded the program. It consists of 4 videotapes, 2 brochures, and a reference book on clinical proceedings. "DMPA: A New Contraceptive Option" is an 18-minute videotape giving an overview of Depo-Provera for physicians and nurse practitioners. It addresses pharmokinetics, efficacy, safety, side effects, patient selection, administration, and medical management of medroxyprogesterone acetate. "DMPA: Patient Counseling and Clinical Staff Procedures" is a 15-minute video including patient counseling scenarios and discussion of usual patient questions. Clients can view the "Choosing a Birth Control Method" video to get a balanced overview of 5 reversible contraceptives. It provides graphics, discussions between patients and providers, and patients' comments on their experiences with the various methods. The fourth video is a Spanish language version of the "Choosing a Birth Control Method" video. One brochure complements the "Choosing a Birth control Method" video; the other one "Questions and Answers About Birth Control Shots", centers on Depo-Provera. ARHP plans to distribute 55,000 copies of its multimedia educational program to health care professionals and to family planning and Planned Parenthood clinics in the US. This program advances and rounds out ARHP'S National Program to Prevent Unintended Pregnancy.     

Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center

Background: Despite the emphasis on patient safety in health care, few organizations have evaluated the extent to which safety is a strategic priority or their culture supports patient safety. In response to the Institute of Medicine's report and to an organizational commitment to patient safety, we conducted a systematic assessment of safety at the Johns Hopkins Hospital (JHH) and, from this, developed a strategic plan to improve safety. The specific aims of this study were to evaluate the extent to which the culture supports patient safety at JHH and the extent to which safety is a strategic priority.

Methods: During July and August 2001 we implemented two surveys in disparate populations to assess patient safety. The Safety Climate Scale (SCS) was administered to a sample of physicians, nurses, pharmacists, and other ICU staff. SCS assesses perceptions of a strong and proactive organizational commitment to patient safety. The second survey instrument, called Strategies for Leadership (SLS), evaluated the extent to which safety was a strategic priority for the organization. This survey was administered to clinical and administrative leaders.

Results: We received 395 completed SCS surveys from 82% of the departments and 86% of the nursing units. Staff perceived that supervisors had a greater commitment to safety than senior leaders. Nurses had higher scores than physicians for perceptions of safety. Twenty three completed SLS surveys were received from 77% of the JHH Patient Safety Committee members and 50% of the JHH Management Committee members. Management Committee responses were more positive than Patient Safety Committee, indicating that management perceived safety efforts to be further developed. Strategic planning received the lowest scores from both committees.

Conclusions: We believe this is one of the first large scale efforts to measure institutional culture of safety and then design improvements in health care. The survey results suggest that strategic planning of patient safety needs enhancement. Several efforts to improve our culture of safety were initiated based on these results, which should lead to measurable improvements in patient safety.