Slater Beverley L, Lawton Rebecca, Armitage Gerry, Bibby John, Wright John
Bradford Institute for Health Research, UK.
J Contin Educ Health Prof. 2012 Spring;32(2):80-9. doi: 10.1002/chp.21130.
Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods.
Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4).
All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes.
This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations.
尽管人们对提高医疗保健安全性和减少医疗差错的兴趣激增，但患者安全的一个重要方面却很少受到关注，即针对全体医疗保健人员的系统教育和培训方法。本文描述了一项对创新的多专业、基于团队的培训项目的评估，该项目将患者安全融入质量改进方法之中。
采用柯克帕特里克的“评估层次”模型，对英格兰北部一个城市的卫生组织中的该项目进行评估。通过问卷调查评估参与者对该项目的反应（第1级）。使用一份包含12个项目的多项选择题问卷和一份文化调查问卷，评估患者安全知识和患者安全文化的改善情况（第2级）。通过访谈和针对项目的定量测量，评估专业实践和患者结局的变化（第3级和第4级）。
参与者对该项目的各个方面都给予了积极评价。很少有参与者在两个时间点都完成了多项选择题，但完成的参与者在知识方面有所提高。患者安全文化有一些虽小但显著的改善。访谈揭示了除所解决的具体问题之外的许多其他益处。最重要的是，11个团队中有8个在患者安全实践和/或结局方面有所改善。
该项目是实践中跨专业教育的一个范例，表明使用质量改进方法的团队学习是可行的，并且在提高患者安全方面可能有效，但需要为参与者提供时间和空间。与继续教育安排保持一致可以支持该方法在组织内的主流采用。
