RegNet, Research School of Pacific and Asian Studies, Australian National University, Canberra, Australian Capital Territory 0200, Australia.
Int J Qual Health Care. 2012 Feb;24(1):88-94. doi: 10.1093/intqhc/mzr078. Epub 2011 Dec 2.
To analyse the strategies used by hospital leaders to improve compliance with the 'ensuring correct patient, correct site and correct procedure protocol'. While following such a protocol saves lives according to an international study of the World Health Organization safe surgery checklist, promoting compliance in hospitals has proved to be a regulatory challenge.
Using a qualitative research design and 'responsive regulation' theory, this study explored implementation strategies used by hospital leaders in 20 Australian public hospitals. Semi-structured interviews were conducted with 72 informants to analyse how front-line leaders improved compliance with the safe surgery protocol in their hospitals.
Implementation analysis of the safe surgery protocol.
The use of implementation strategies located on a 'responsive regulation' pyramid.
Informants identified many strategies used to improve protocol compliance typically beginning with persuasion. Supportive strategies were located on a regulatory pyramid beginning with softer interventions: persuade, enlist leaders, train, remind, relax protocol requirements, redesign hospital systems and reward compliance. In response to low and slow compliance, many hospital leaders switched to a pyramid of escalating sanctions: direct, delegate, monitor, publicly report, reprimand and penalize.
A multiplex problem requires graduated and multiplex regulation. Hospital leaders proved to be responsive regulators in applying both multiple supports and sanctions that improved compliance over 3 years. These experiences with protocol implementation illustrate the multifaceted challenge of health sector regulation and offer lessons for embedding future patient safety solutions.
分析医院领导为提高“确保正确的患者、正确的部位和正确的手术程序”的依从性而采用的策略。虽然根据世界卫生组织安全手术核对表的一项国际研究，遵循这样的方案可以拯救生命，但在医院中提高依从性已被证明是一项监管挑战。
本研究采用定性研究设计和“响应式监管”理论，探讨了 20 家澳大利亚公立医院的医院领导采用的实施策略。对 72 名知情人进行了半结构化访谈，以分析一线领导如何在其医院提高安全手术方案的依从性。
对安全手术方案的实施进行分析。
响应式监管金字塔上的实施策略的使用。
知情人确定了许多旨在提高方案依从性的策略，这些策略通常从劝说开始。支持性策略位于监管金字塔上，从更温和的干预措施开始：说服、争取领导、培训、提醒、放宽方案要求、重新设计医院系统和奖励合规性。针对依从性低和缓慢的情况，许多医院领导转而采用制裁的金字塔式方法：直接干预、委托、监测、公开报告、谴责和惩罚。
一个复杂的问题需要分级和多重监管。医院领导被证明是有响应能力的监管者，他们在 3 年内同时采用了多种支持和制裁措施，从而提高了依从性。这些方案实施经验说明了卫生部门监管的多面性挑战，并为未来的患者安全解决方案提供了经验教训。
