Dixon Nancy M, Shofer Marjorie
Common Knowledge Associates, 2857 Selma Lane, Dallas, TX 75234, USA.
Health Serv Res. 2006 Aug;41(4 Pt 2):1618-32. doi: 10.1111/j.1475-6773.2006.00568.x.
The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety initiatives should be sequenced, the lack of benchmarking data to measure their systems against and the pressing need for IT standardization. The insights from this customer needs assessment revealed a wealth of implementation knowledge in the field and has led AHRQ to create an opportunity for leading edge health care systems to learn from each other via learning networks.
医疗保健研究与质量局（AHRQ）的使命一直是支持并开展卫生服务研究，以及传播这些研究成果。最近，该机构将其使命改为：“提高所有美国人医疗保健的质量、安全性、效率和有效性。”对于从事患者安全主题工作的机构人员而言，这一变化使得他们有必要更深入地了解领先医疗保健系统当前正在开展的患者安全举措，以便确定AHRQ在帮助这些系统更快地采用新做法以改善患者安全方面能够发挥最佳作用的领域。为了做出这一决定，AHRQ对选定医疗保健系统的领导者进行了客户需求评估，询问他们有关当前实施举措以及他们对持续实施患者安全举措的感知需求的问题。尽管此次访谈并非作为一项研究进行设计或实施，但为时一小时的访谈为患者安全举措的实施努力提供了丰富的见解。在每个医疗保健系统中接受访谈的高级领导者描述了在多个方面实施患者安全举措的情况——在一些系统中，多达15项举措正在进行。正如举措的数量所证明的那样，对于应该实施哪些患者安全做法（电子病历医嘱录入系统、快速反应团队、减少手术部位感染）并不缺乏了解，相反，这些医疗保健系统面临的主要难题是实施的“方法”。大多数举措才刚刚开始，因此这些领导者对从这些努力中学到的东西以及这些举措能否长期持续下去尚无信心。这些医疗保健系统的许多举措创意都来自医疗保健领域之外，例如核电行业或航空业。高管们对一系列问题表示担忧，包括：患者安全举措应如何排序、缺乏用于与自身系统进行对比的基准数据，以及对信息技术标准化的迫切需求。此次客户需求评估的见解揭示了该领域丰富的实施知识，并促使AHRQ为前沿医疗保健系统创造了一个通过学习网络相互学习的机会。
