Espin S, Lingard L, Baker G R, Regehr G
Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Canada.
Qual Saf Health Care. 2006 Jun;15(3):165-70. doi: 10.1136/qshc.2005.017475.
This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of "vulnerable system syndrome", Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into key trends in the interview data, including team members' definition of error as the breaching of standards of practice, nurses' sense of scope of practice as a constraint on their reporting behaviours, and participants' reports of the forces influencing tacit agreements to work around safety regulations. However, the relational factors underlying unsafe practice routines are poorly accounted for in these theoretical approaches. Incorporating an additional theoretical construct such as "relational coordination" to account for the emotional human features of team practice would provide a more comprehensive theoretical approach for use in exploring unsafe practice routines and the forces that sustain them in healthcare team settings.
本文探讨了影响医疗保健跨专业团队环境中不安全行为持续存在的因素，旨在构建一个描述性理论模型，用于分析有问题的行为惯例。通过对手术室团队28名成员进行混合方法访谈研究收集数据，运用组织心理学和认知心理学的以下三种理论模型分析参与者对不安全行为的处理方式：瑞森的“脆弱系统综合征”理论、塔克和埃德蒙森的一阶和二阶问题解决概念以及阿马尔贝蒂的行为迁移模型。这三种理论方法为访谈数据中的关键趋势提供了批判性见解，包括团队成员将错误定义为违反行为标准、护士将行为范围感视为对其报告行为的限制，以及参与者报告影响围绕安全规定达成默契协议的因素。然而，这些理论方法对不安全行为惯例背后的关系因素考虑不足。纳入诸如“关系协调”等额外理论结构以解释团队行为中的情感人性特征，将为探索医疗团队环境中的不安全行为惯例及其维持因素提供更全面的理论方法。
