Paine Lori A, Baker David R, Rosenstein Beryl, Pronovost Peter J
The John Hopkins Hospital, Baltimore, USA.
Jt Comm J Qual Saf. 2004 Oct;30(10):543-50. doi: 10.1016/s1549-3741(04)30064-x.
At The Johns Hopkins Hospital (JHH), a culture of safety refers to the presence of characteristics such as the belief that harm is untenable and the use of a systems approach to analyzing safety issues.
The leadership of JHH provides strategic planning guidance for safety and improvement initiatives, involves the patient safety committee in capital investment allocation decisions and in designing and planning new hospital facilities, and ensures that safety and quality head the agenda of board-of-trustees meetings. Although JHH takes a systems approach, structures such as monitoring staff behavior trends are used to hold people accountable for job performance.
JHH encountered three major hurdles in implementing and sustaining a culture of safety. First, JHH's decentralized organizational structure contributes to a silo effect that limits the spread of ideas, practices, and culture. JHH intends to create an internal collaborative of departmental safety initiatives to foster opportunities for units to share ideas and results. Second, in response to the challenge of encouraging teams to think and act in an interdisciplinary fashion, communication and teamwork training are being used to enhance the effectiveness of interdisciplinary teams. Further development of valid and meaningful safety-related measurement and data collection methodologies is JHH's largest remaining challenge.
在约翰霍普金斯医院（JHH），安全文化指的是具备诸如认为伤害是不可接受的信念以及采用系统方法分析安全问题等特征。
JHH的领导层为安全与改进举措提供战略规划指导，让患者安全委员会参与资本投资分配决策以及新医院设施的设计和规划，并确保安全与质量成为董事会会议议程的首要事项。尽管JHH采用系统方法，但诸如监测员工行为趋势等结构被用于让人们对工作表现负责。
JHH在实施和维持安全文化方面遇到了三大障碍。首先，JHH的分散式组织结构导致了筒仓效应，限制了想法、实践和文化的传播。JHH打算创建一个部门安全举措的内部协作机制，以促进各单位分享想法和成果的机会。其次，为应对鼓励团队以跨学科方式思考和行动的挑战，正在使用沟通和团队合作培训来提高跨学科团队的有效性。有效且有意义的安全相关测量和数据收集方法的进一步发展是JHH目前最大的挑战。
