Pronovost P J, Weast B, Holzmueller C G, Rosenstein B J, Kidwell R P, Haller K B, Feroli E R, Sexton J B, Rubin H R
The Johns Hopkins Hospital, Baltimore, MD, USA.
Qual Saf Health Care. 2003 Dec;12(6):405-10. doi: 10.1136/qhc.12.6.405.
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.
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.
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.
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.
尽管医疗保健领域强调患者安全，但很少有机构评估安全在多大程度上是战略重点，以及其文化是否支持患者安全。为响应医学研究所的报告以及机构对患者安全的承诺，我们对约翰霍普金斯医院（JHH）的安全状况进行了系统评估，并据此制定了一项改善安全的战略计划。本研究的具体目标是评估JHH的文化在多大程度上支持患者安全，以及安全在多大程度上是战略重点。
2001年7月和8月期间，我们对不同人群进行了两项调查以评估患者安全。安全氛围量表（SCS）应用于医生、护士、药剂师和其他重症监护室工作人员的样本。SCS评估对强大且积极主动的机构患者安全承诺的认知。第二项调查工具名为领导策略（SLS），评估安全在多大程度上是该机构的战略重点。这项调查应用于临床和行政领导。
我们收到了来自82%的科室和86%的护理单元的395份完整的SCS调查问卷。工作人员认为主管对安全的承诺比高层领导更大。护士对安全的认知得分高于医生。从JHH患者安全委员会77%的成员和JHH管理委员会50%的成员那里收到了23份完整的SLS调查问卷。管理委员会的回应比患者安全委员会更积极，表明管理层认为安全工作有待进一步开展。两个委员会对战略规划的评分最低。
我们认为这是首批大规模衡量机构安全文化并随后设计医疗保健改进措施的努力之一。调查结果表明患者安全的战略规划需要加强。基于这些结果，我们启动了几项改善安全文化的举措，这应该会带来患者安全方面可衡量的改善。
