Weingart Saul N, Farbstein Ken, Davis Roger B, Phillips Russell S
Stoneman Center for Quality Improvement, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, USA.
Jt Comm J Qual Saf. 2004 Mar;30(3):125-32. doi: 10.1016/s1549-3741(04)30014-6.
A culture of safety survey was used to study features of the safety culture and their relationship with patient safety indicators.
Anonymous written surveys were collected from 455 of 1,027 (44%) workers at four Massachusetts hospitals. Respondents characterized their organizations' patient safety, workplace safety, and features of a safety culture, such as leadership commitment, professional salience, presence of a nonpunitive environment, error reporting, and communication.
Employees universally regarded patient safety as an essential part of their job. Two-thirds of workers worried at least once a day about making a mistake that could injure a patient; 43% said that the work load hindered their ability to keep patients safe. Workers' overall assessment of patient safety was associated with their perceptions of workplace safety (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.02-3.43, p = .044) and leadership commitment to patient safety (OR 3.20, 95% CI 1.97-5.19, p < .001). Incident reporting rates correlated with survey results, while adoption of best practices and expert opinion did not.
Patient safety is salient to workers, who universally embraced patient safety as an essential part of their job. Independent indicators of patient safety did not line up neatly with safety culture survey results. Incident reporting rates correlated directly, while adoption of best practices and expert opinion varied inversely with survey results. The safety culture is a complex phenomenon that requires further study.
采用安全文化调查来研究安全文化的特征及其与患者安全指标的关系。
从马萨诸塞州四家医院的1027名员工中收集了455份（44%）匿名书面调查问卷。受访者对其所在机构的患者安全、工作场所安全以及安全文化的特征进行了描述，如领导承诺、职业重要性、无惩罚环境的存在、错误报告和沟通情况。
员工普遍将患者安全视为其工作的重要组成部分。三分之二的员工每天至少担心一次会犯可能伤害患者的错误；43%的员工表示工作量妨碍了他们保障患者安全的能力。员工对患者安全的总体评估与他们对工作场所安全的认知相关（优势比[OR]为1.87，95%置信区间[CI]为1.02 - 3.43，p = 0.044）以及领导对患者安全的承诺相关（OR为3.20，95% CI为1.97 - 5.19，p < 0.001）。事件报告率与调查结果相关，而最佳实践的采用情况和专家意见与调查结果无关。
患者安全对员工而言很突出，他们普遍将患者安全视为工作的重要组成部分。患者安全的独立指标与安全文化调查结果并不完全一致。事件报告率直接相关，而最佳实践的采用情况和专家意见与调查结果呈反向变化。安全文化是一种复杂的现象，需要进一步研究。
