Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Annu Rev Public Health. 2013;34:373-96. doi: 10.1146/annurev-publhealth-031912-114439. Epub 2013 Jan 16.
Hospital errors are a seemingly intractable problem and continuing threat to public health. Errors resist intervention because too often the interventions deployed fail to address the fundamental source of errors: weak organizational safety culture. This review applies and extends a theoretical model of safety culture that suggests it is a function of interrelated processes of enabling, enacting, and elaborating that can reduce hospital errors over time. In this model, enabling activities help shape perceptions of safety climate, which promotes enactment of safety culture. We then classify a broad array of interventions as enabling, enacting, or elaborating a culture of safety. Our analysis, which is intended to guide future attempts to both study and more effectively create and sustain a safety culture, emphasizes that isolated interventions are unlikely to reduce the underlying causes of hospital errors. Instead, reducing errors requires systemic interventions that address the interrelated processes of safety culture in a balanced manner.
医院差错是一个看似棘手且持续威胁公众健康的问题。差错难以干预，因为干预措施往往未能解决差错的根本原因：薄弱的组织安全文化。本综述应用和扩展了安全文化的理论模型，该模型表明，它是一系列相互关联的使能、实施和细化过程的功能，这些过程可以随着时间的推移减少医院差错。在该模型中，使能活动有助于塑造安全氛围的认知，从而促进安全文化的实施。然后，我们将广泛的干预措施分类为使能、实施或细化安全文化。我们的分析旨在为未来研究和更有效地创建和维持安全文化提供指导，强调孤立的干预措施不太可能减少医院差错的根本原因。相反，减少差错需要系统干预，以平衡的方式解决安全文化的相互关联的过程。
