Singh Ranjit, Hickner John, Mold Jim, Singh Gurdev
From the *UB Patient Safety Research Center, State University of New York at Buffalo, Buffalo, New York; †Department of Family Medicine, The Cleveland Clinic, Cleveland, Ohio; and ‡Department of Family and Preventive Medicine, University of Oklahoma, Norman, Oklahoma.
J Patient Saf. 2014 Mar;10(1):20-8. doi: 10.1097/PTS.0b013e3182a5f81a.
Testing plays a vital role in primary care. Failures in the process are common and can be harmful. As the great 19th century microbiologist Louis Pasteur put it "chance favors only the prepared mind." Our objective is to prepare minds in primary care practices to improve safety in the testing process. Various principles from safety science can be applied.
A prospective methodology that uses an anonymous practice survey based on concepts from failure modes and effects analysis is proposed. Responses are used to rank perceived hazards in the testing process, leading to prioritization of areas for intervention. Secondary data analysis (using data from a study of medication safety) was used to explore the value of this approach in the context of assessing the testing process.
At 3 primary care practice sites, a total of 61 staff members completed 4 survey items examining the testing process. Comparison across practices shows that each has a distinct profile of hazards, which would lead each on a different path toward improvement.
The proposed approach treats each practice as a unique complex adaptive system aiming to help it thrive by inculcating trust, mutual respect, and collaboration. Implications for patient safety research and practice are discussed.
检测在初级保健中起着至关重要的作用。检测过程中的失误很常见，且可能有害。正如19世纪伟大的微生物学家路易·巴斯德所说：“机遇只偏爱有准备的头脑。”我们的目标是让初级保健机构中的人员做好准备，以提高检测过程的安全性。安全科学的各种原则都可以应用。
提出一种前瞻性方法，该方法基于失效模式与效应分析的概念进行匿名的机构调查。调查结果用于对检测过程中感知到的危害进行排序，从而确定干预领域的优先级。二次数据分析（使用药物安全研究的数据）用于在评估检测过程的背景下探索这种方法的价值。
在3个初级保健机构中，共有61名工作人员完成了4项关于检测过程的调查项目。各机构之间的比较表明，每个机构都有独特的危害特征，这将使每个机构朝着不同的改进方向发展。
所提出的方法将每个机构视为一个独特的复杂适应系统，旨在通过灌输信任、相互尊重和协作来帮助其蓬勃发展。讨论了对患者安全研究和实践的影响。
