RAND Corporation, Santa Monica, California, USA.
BMJ Qual Saf. 2011 Jul;20(7):611-7. doi: 10.1136/bmjqs.2010.049379. Epub 2011 May 26.
Differences in contexts (eg, policies, healthcare organisation characteristics) may explain variations in the effects of patient safety practice (PSP) implementations. However, knowledge of which contextual features are important determinants of PSP effectiveness is limited and consensus is lacking on a taxonomy of which contexts matter.
Iterative, formal discussions were held with a 22-member technical expert panel composed of experts or leaders in patient safety, healthcare systems, and methods. First, potentially important contextual features were identified, focusing on five PSPs. Then, two surveys were conducted to determine the context likely to influence PSP implementations.
The panel reached a consensus on a taxonomy of four broad domains of contextual features important for PSP implementations: safety culture, teamwork and leadership involvement; structural organisational characteristics (eg, size, organisational complexity or financial status); external factors (eg, financial or performance incentives or PSP regulations); and availability of implementation and management tools (eg, training organisational incentives). Panelists also tended to rate specific patient safety culture, teamwork and leadership contexts as high priority for assessing their effects on PSP implementations, but tended to rate specific organisational characteristic contexts as high priority only for use in PSP evaluations. Panelists appeared split on whether specific external factors and implementation/management tools were important for assessment or only description.
This work can guide research commissioners and evaluators on the contextual features of PSP implementations that are important to report or evaluate. It represents a first step towards developing guidelines on contexts in PSP implementation evaluations. However, the science of context measurement needs maturing.
背景（例如政策、医疗保健组织特征）的差异可能解释了患者安全实践（PSP）实施效果的差异。然而，对于哪些背景特征是 PSP 有效性的重要决定因素的了解有限，并且缺乏关于哪些背景重要的分类法的共识。
与由患者安全、医疗保健系统和方法方面的专家或领导者组成的 22 名技术专家组成员进行了迭代、正式的讨论。首先，确定了五个 PSP 中可能重要的背景特征。然后，进行了两项调查，以确定可能影响 PSP 实施的背景。
专家组就 PSP 实施的四个广泛的背景特征领域的分类法达成共识：安全文化、团队合作和领导力参与；结构组织特征（例如，规模、组织复杂性或财务状况）；外部因素（例如，财务或绩效激励或 PSP 法规）；以及实施和管理工具的可用性（例如，培训组织激励）。小组成员还倾向于将特定的患者安全文化、团队合作和领导力背景评为评估其对 PSP 实施影响的高优先级，但倾向于仅将特定的组织特征背景评为 PSP 评估中高优先级的用途。小组成员似乎对特定的外部因素和实施/管理工具是否对评估或仅描述很重要存在分歧。
这项工作可以指导 PSP 实施的背景特征的研究委托人和评估人员，这些特征对于报告或评估很重要。它代表了制定 PSP 实施评估中背景指南的第一步。然而，背景测量的科学需要成熟。
