Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine, 1909 Thames Street, 2nd floor, Baltimore, MD 21231, USA.
BMJ Qual Saf. 2012 Oct;21(10):872-5. doi: 10.1136/bmjqs-2011-000470. Epub 2012 May 5.
Healthcare has made great efforts to reduce preventable patient harm, from externally driven regulations to internally driven professionalism. Regulation has driven the majority of efforts to date, and has a necessary place in establishing accountability and minimum standards. Yet they need to be coupled with internally driven efforts. Among professional groups, internally-driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, yet these approaches are underdeveloped in healthcare. Healthcare can learn much from the nuclear power industry. The nuclear power industry formed the Institute of Nuclear Power Operators following the Three Mile Island accident to improve safety. That organization established a peer-to-peer assessment program to cross-share best practices, safety hazards, problems and actions that improved safety and operational performance. This commentary explores how a similar program could be expanded into healthcare. Healthcare needs a structured, clinician-led, industry-wide process to openly review, identify and mitigate hazards, and share best practices that ultimately improve patient safety. A healthcare version of the nuclear power program could supplement regulatory and other strategies currently used to improve quality and patient safety.
医疗保健行业为减少可预防的患者伤害做出了巨大努力，从外部推动的法规到内部推动的专业精神。到目前为止，大多数努力都是由法规推动的，而法规在建立问责制和最低标准方面具有必要的地位。然而，它们需要与内部驱动的努力相结合。在专业群体中，作为学习共同体并改变社会规范的内部驱动努力是提高绩效的非常有效的工具，但这些方法在医疗保健领域还不够发达。医疗保健可以从核电行业学到很多东西。核电行业在三里岛事故后成立了核动力操作人员研究所，以提高安全性。该组织建立了一个同行评估计划，以交叉共享最佳实践、安全隐患、问题和提高安全性和运营绩效的行动。本评论探讨了如何将类似的计划扩展到医疗保健领域。医疗保健需要一个由临床医生领导的、结构化的、全行业的流程，以公开审查、识别和减轻危害，并分享最终提高患者安全性的最佳实践。医疗保健版本的核电计划可以补充目前用于提高质量和患者安全的监管和其他策略。
