Rea David, Griffiths Sarah
Department of Public Health and Policy Studies, College of Human and Health Sciences, Swansea University, Swansea, UK.
Health Soc Care Community. 2016 Jul;24(4):411-9. doi: 10.1111/hsc.12221. Epub 2015 Mar 25.
Over the past 20 years, healthcare has adapted to the 'quality revolution' by moving away from direct provision and hierarchical control mechanisms. In their place, new structures based on contractual relationships are being developed coupled with attempts to create an organisational culture that shares learning and that scrutinises existing practice so that it can be improved. The issue here is that contractual arrangements require surveillance, monitoring, regulation and governance systems that can be perceived as antipathetic to the examination of practice and subsequent learning. Historically, reporting levels from general practice have remained low; little information is shared and consequently lessons are not shared across the general practice community. Given large-scale under-engagement of general practitioners (GPs) in incident reporting systems, significant event analysis is advocated to encourage sharing of information about incidents to inform the patient safety agenda at a local and national level. Previous research has concentrated on the secondary care environment and little is known about the situation in primary care, where the majority of patient contacts with healthcare occur. To explore attitudes to incident reporting, the study adopted a qualitative approach to GPs working in a mixture of urban and rural practices reporting to a Welsh Local Health Board. The study found that GPs used significant event analysis methodology to report incidents within their practice, but acknowledged under-reporting. They were less enthusiastic about reporting externally. A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment. If incident reporting processes are perceived as supportive and formative, and where protected time is allocated to discuss incidents, then GPs are willing to participate. They also need to know how the information is used, and whether lessons are being learnt from errors.
在过去20年里，医疗保健行业通过摒弃直接提供服务和层级控制机制，适应了“质量革命”。取而代之的是，基于合同关系的新结构正在形成，同时还尝试营造一种共享学习经验并审视现有做法以便改进的组织文化。这里的问题在于，合同安排需要监督、监测、监管和治理系统，而这些系统可能被视为不利于对实践进行审视和后续学习。从历史上看，全科医疗的报告水平一直很低；信息很少共享，因此经验教训也没有在全科医疗社区中共享。鉴于全科医生对事件报告系统的参与度普遍较低，有人主张进行重大事件分析，以鼓励分享有关事件的信息，为地方和国家层面的患者安全议程提供参考。以往的研究主要集中在二级医疗环境，对于初级医疗环境（大多数患者与医疗保健机构接触的地方）的情况了解甚少。为了探究对事件报告的态度，该研究采用定性研究方法，对向威尔士地方卫生委员会报告的城乡混合诊所工作的全科医生进行了调查。研究发现，全科医生使用重大事件分析方法在其诊所内报告事件，但承认报告不足。他们对外部报告的积极性较低。报告存在一些障碍，包括报告时间不足、缺乏反馈、害怕被指责以及在竞争环境中声誉受损和患者信心受挫。如果事件报告流程被视为具有支持性和建设性，并且分配了专门时间来讨论事件，那么全科医生愿意参与。他们还需要知道信息是如何使用的，以及是否从错误中吸取了教训。
