Weingart Saul N, Simchowitz Brett, Eng Terry Kahlert, Morway Laurinda, Spencer Justin, Zhu Junya, Cleary Christine, Korman-Parra Janet, Horvath Kathleen
Center for Patient Safety, Dana-Farber Cancer Institute, Boston, USA.
Jt Comm J Qual Patient Saf. 2009 Feb;35(2):63-71. doi: 10.1016/s1553-7250(09)35009-6.
Health care organizations have begun to adapt high-performance teamwork training techniques from aviation to clinical environments. Oncology care is often delivered in multispecialty teams and with the patient's and family's active involvement. To examine the potential value of a patient-oriented teamwork intervention, a teamwork training initiative for oncology patients and their families was developed at the Dana-Farber Cancer Institute.
The content and format of the initiative evolved iteratively on the basis of several core team-training concepts derived from the research literature in health care and aviation. Initially a targeted intervention, the program evolved into a multifaceted campaign that included internal marketing, staff training, and one-on-one patient outreach by a group of volunteers. The You CAN campaign sought to convey a positive and empowering message that encouraged patients to (1) check for hazards in the environment, (2) ask questions of clinicians, and (3) notify staff of safety concerns.
The You CAN campaignwas conducted from July through September 2007. To assess its progress, patients were surveyed at baseline and during the campaign. On the basis of the survey results, 32% (95% confidence interval [CI]: 25%-38%) of the ambulatory clinic population, or 1,145 patients, were exposed to the campaign. Although patients rated the quality of teamwork and communication favorably at both baseline and followup, there was no significant change in the self-reported use of teamwork techniques on a written survey. However, 39% (95% CI: 27%-51%) of those who were exposed to the campaign said that it changed their behavior.
A training program for patients and their families is feasible in ambulatory oncology and may be applicable to other clinical settings.
医疗保健机构已开始将航空领域的高效团队协作培训技术应用于临床环境。肿瘤护理通常由多专业团队提供,且患者及其家属也积极参与其中。为了探究以患者为导向的团队协作干预措施的潜在价值,达纳 - 法伯癌症研究所开展了一项针对肿瘤患者及其家属的团队协作培训项目。
该项目的内容和形式基于从医疗保健和航空领域的研究文献中得出的几个核心团队培训概念反复演变。该项目最初是一项有针对性的干预措施,后来演变成一个多方面的活动,包括内部推广、员工培训以及一组志愿者开展的一对一患者宣传活动。“你能做到”活动旨在传达一个积极且鼓舞人心的信息,鼓励患者:(1)检查环境中的危险因素;(2)向临床医生提问;(3)将安全问题告知工作人员。
“你能做到”活动于2007年7月至9月开展。为评估其进展情况,在基线期和活动期间对患者进行了调查。根据调查结果,门诊患者中有32%(95%置信区间[CI]:25% - 38%),即1145名患者接触到了该活动。尽管患者在基线期和随访时对团队协作和沟通质量的评价都很高,但在书面调查中,自我报告的团队协作技术使用情况并无显著变化。然而,接触到该活动的患者中有39%(95%CI:27% - 51%)表示活动改变了他们的行为。
针对患者及其家属的培训项目在门诊肿瘤护理中是可行的,可能也适用于其他临床环境。