Sutcliffe Kathleen M, Lewton Elizabeth, Rosenthal Marilynn M
University of Michigan Business School, Ann Arbor, Michigan 48109-1334, USA.
Acad Med. 2004 Feb;79(2):186-94. doi: 10.1097/00001888-200402000-00019.
To describe how communication failures contribute to many medical mishaps.
In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data.
Residents reported a total of 70 mishap incidents. Aspects of "communication" and "patient management" were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps.
The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.
描述沟通失误如何导致众多医疗事故。
1999年末，从美国一家拥有600张床位的教学医院的85名住院医师中，随机抽取了26名按医学专业、住院年份和性别分层的住院医师作为样本。该研究设计包括与住院医师进行半结构化面对面访谈，内容涉及他们的日常工作环境和活动、他们最近参与的医疗事故，以及对个人和组织促成因素的描述。此处报告的主题来自对数据的归纳分析。
住院医师共报告了70起事故事件。“沟通”和“患者管理”方面是最常被提及的促成因素。住院医师将自己描述为置身于一个复杂的关系网络中，在与医院内部和社区的其他医务人员及医疗服务提供者共同进行患者管理方面发挥着关键作用。在这些关系中反复出现沟通困难的模式，且似乎与医疗事故的发生有关。
本研究中日常医疗事故的发生与沟通失误有关；但是，沟通不畅不仅仅是信息传递或交流不佳的结果。沟通失误要复杂得多，与层级差异、对向上影响力的担忧、角色冲突和角色模糊，以及人际权力和冲突有关。对这些动态有更清晰的理解，凸显了在医学教育和医疗保健组织中进行适当干预以提高患者安全的可能性。
