Appelbaum Nital P, Dow Alan, Mazmanian Paul E, Jundt Dustin K, Appelbaum Eric N
Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Saint Louis University, St Louis, Missouri, USA.
Med Educ. 2016 Mar;50(3):343-50. doi: 10.1111/medu.12947.
Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under-reported, especially by frontline providers such as resident physicians.
This study describes and tests relationships between power distance and leader inclusiveness on psychological safety and the willingness of residents to report adverse events.
A total of 106 resident physicians from the departments of neurosurgery, orthopaedic surgery, emergency medicine, otolaryngology, neurology, obstetrics and gynaecology, paediatrics and general surgery in a mid-Atlantic teaching hospital were asked to complete a survey on psychological safety, perceived power distance, leader inclusiveness and intention to report adverse events.
Perceived power distance (β = -0.26, standard error [SE] 0.06, 95% confidence interval [CI] -0.37 to 0.15; p < 0.001) and leader inclusiveness (β = 0.51; SE 0.07, 95% CI 0.38-0.65; p < 0.001) both significantly predicted psychological safety, which, in turn, significantly predicted intention to report adverse events (β = 0.34; SE 0.08, 95% CI 0.18-0.49; p < 0.001). Psychological safety significantly mediated the direct relationship between power distance and intention to report adverse events (indirect effect: -0.09; SE 0.02, 95% CI -0.13 to 0.04; p < 0.001). Psychological safety also significantly mediated the direct relationship between leader inclusiveness and intention to report adverse events (indirect effect: 0.17; SE 0.02, 95% CI 0.08-0.27; p = 0.001).
Psychological safety was found to be a predictor of intention to report adverse events. Perceived power distance and leader inclusiveness both influenced the reporting of adverse events through the concept of psychological safety. Because adverse event reporting is shaped by relationships and culture external to the individual, it should be viewed as an organisational as much as a personal function. Supervisors and other leaders in health care should ensure that policies, procedures and leadership practices build psychological safety and minimise power distance between low- and high-status members in order to support greater reporting of adverse events.
尽管报告不良事件是识别和解决患者安全失误的必要第一步，但此类事件报告不足，尤其是住院医师等一线医疗人员。
本研究描述并检验权力距离和领导包容性与心理安全之间的关系，以及住院医师报告不良事件的意愿。
来自大西洋中部一家教学医院神经外科、整形外科、急诊医学、耳鼻喉科、神经内科、妇产科、儿科和普通外科的106名住院医师被要求完成一项关于心理安全、感知权力距离、领导包容性和报告不良事件意愿的调查。
感知权力距离（β = -0.26，标准误[SE] 0.06，95%置信区间[CI] -0.37至0.15；p < 0.001）和领导包容性（β = 0.51；SE 0.07，95% CI 0.38 - 0.65；p < 0.001）均显著预测心理安全，而心理安全又显著预测报告不良事件的意愿（β = 0.34；SE 0.08，95% CI 0.18 - 0.49；p < 0.001）。心理安全显著中介了权力距离与报告不良事件意愿之间的直接关系（间接效应：-0.09；SE 0.02，95% CI -0.13至0.04；p < 0.001）。心理安全还显著中介了领导包容性与报告不良事件意愿之间的直接关系（间接效应：0.17；SE 0.02，95% CI 0.08 - 0.27；p = 0.001）。
发现心理安全是报告不良事件意愿的一个预测因素。感知权力距离和领导包容性均通过心理安全概念影响不良事件报告。由于不良事件报告受个体外部的关系和文化影响，它应被视为一种组织功能，也是个人功能。医疗保健领域的主管和其他领导者应确保政策、程序和领导实践建立心理安全，并尽量减少低地位和高地位成员之间的权力距离，以支持更多地报告不良事件。
