Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
BMJ Qual Saf. 2013 Jul;22(7):554-62. doi: 10.1136/bmjqs-2012-000843. Epub 2013 Feb 27.
Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS).
Thirty-three qualitative interviews with a representative sample of patients from six units in a teaching hospital in the north of England were carried out. Patients were asked either to describe their most recent/current hospital experience (unstructured) or were asked to describe their experience in relation to specific contributory factors (structured). Responses were coded using the YCFF. Face validity of the PMOS was tested with 12 patients and 12 health professionals, using a 'think aloud' approach, and appropriate revisions made. The research was supported by two patient representatives.
Patients were able to comment on/identify 13 of the 20 contributory factors contained within the YCFF domains. They identified contributory factors relating to communication and individual factors more frequently, and contributory factors relating to team factors, and support from central functions less frequently. In addition, they identified one theme not included in the YCFF: dignity and respect. The draft PMOS showed acceptable face validity.
Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements.
高风险行业已经开发出主动识别导致事故因素的工具。尽管患者会对其在医院的护理体验提供反馈，但目前还没有要求患者对导致患者安全事件的因素发表意见的措施。本研究的目的是确定患者在医院环境中能够识别的、来自约克郡促成因素框架（YCFF）的促成因素，并利用这些信息开发患者安全度量（PMOS）。
在英格兰北部一所教学医院的六个科室中，对具有代表性的患者样本进行了 33 次定性访谈。患者被要求描述他们最近/目前的医院经历（非结构化），或者要求他们根据特定的促成因素描述他们的经历（结构化）。使用 YCFF 对响应进行编码。使用“出声思考”的方法，由 12 名患者和 12 名卫生专业人员对 PMOS 的表面有效性进行了测试，并进行了适当的修订。这项研究得到了两名患者代表的支持。
患者能够对 YCFF 各领域中包含的 20 个促成因素中的 13 个发表意见/识别。他们更频繁地识别出与沟通和个人因素有关的促成因素，而与团队因素和来自中央职能部门的支持有关的促成因素识别较少。此外，他们还识别出一个 YCFF 中未包含的主题：尊严和尊重。PMOS 的草案表现出良好的表面有效性。
患者能够识别出影响其护理安全的因素。PMOS 提供了一种系统评估这些因素的方法，有可能帮助卫生专业人员和医疗保健组织从患者的角度了解和识别安全问题，并在此过程中进行适当的服务改进。
