Department of Industrial Engineering and Management, Graduate School of Decision Science and Technology, Tokyo Institute of Technology, Japan.
J Patient Saf. 2011 Dec;7(4):204-12. doi: 10.1097/PTS.0b013e3182388d0d.
The present paper has 2 primary objectives as a pilot study on health-care safety climate in China: to develop its prototypical model well fit to the country's current hospital situations and validated external reliability and to elicit essential characteristics of safety climate for hypothetical general features in Chinese health care.
A safety climate survey was carried out in 2008 at a university hospital in Shanghai, using an Operating Room Management Attitudes Questionnaire. We collected 1056 valid responses from doctors and nurses with 81% of overall response rate.
A 9-dimension model of safety climate was developed by applying principal component analysis to the entire sample with 44% of cumulative variance accounted for. Compared with the Japanese sample, safety climate in the Chinese hospital was characterized as strong awareness of own competence, positive attitudes to organization, but large power distance and unrealistic staff recognition of human error. Criterion validity of the construct was in part assured by significant correlations of 4 dimensions with self-reported staff behavior of accident reporting.
Safety climate has been not yet mature in the hospital surveyed that might be partly tied with blame culture. Considering health-care policies, procedures, and management styles shared with many other health-care organizations as well as Chinese culture, we would hypothesize that the immature nature is common in Chinese health care as overall characteristics of safety climate. From these results, we would suggest that a nonpunitive health-care culture should be fostered to improve patient safety in China.
本研究旨在对中国医疗保健安全氛围进行探索性研究，以开发适合中国当前医院情况的原型模型，并验证其外部可靠性，并提取中国医疗保健中假设的一般特征的安全氛围的基本特征。
2008 年，我们在上海的一家大学医院使用手术室管理态度问卷进行了安全氛围调查。我们共收集了 1056 名医生和护士的有效回复，总体回复率为 81%。
通过对整个样本进行主成分分析，我们开发了一个 9 维度的安全氛围模型，占总方差的 44%。与日本样本相比，中国医院的安全氛围表现为强烈的自我能力意识、对组织的积极态度，但权力距离较大，员工对人为错误的认识不切实际。该结构的效标效度部分通过 4 个维度与自我报告的员工事故报告行为的显著相关性得到保证。
在所调查的医院中，安全氛围还不够成熟，这可能部分与责备文化有关。考虑到与许多其他医疗机构共享的医疗保健政策、程序和管理方式以及中国文化，我们假设不成熟是中国医疗保健安全氛围的总体特征。根据这些结果，我们建议培养一种非惩罚性的医疗保健文化，以提高中国的患者安全。
