Yousefinezhadi Taraneh, Jannesar Nobari Farnaz Attar, Behzadi Goodari Faranak, Arab Mohammad
Ph.D. Student of Health Policy, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran.
Glob J Health Sci. 2016 Sep 1;8(9):52635. doi: 10.5539/gjhs.v8n9p207.
In any complex human system, human error is inevitable and shows that can't be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU's process failure modes at the point of systematic approach to errors.
In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures' Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM).
Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM.
Applying of modified PFMEA for improving two selected ICUs' processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives.
在任何复杂的人类系统中，人为失误都是不可避免的，这表明不能通过指责犯错者来消除失误。因此，为了提高医院重症监护病房（ICU）的可靠性，本研究试图从系统的失误方法角度识别和分析ICU的流程失效模式。
在这项描述性研究中，2014年通过观察、文档审查以及与德黑兰两家选定ICU的流程负责人进行焦点小组讨论（FGD）来定性收集数据。但是，基于所使用的失效模式与效应分析（FMEA）方法中的失效风险优先数（RPN）进行定量数据分析。此外，通过定性的埃因霍温分类模型（ECM）分析了一些失效原因。
通过FMEA方法，在医院A中识别并评估了180项ICU活动中的378种潜在失效模式，在医院B中识别并评估了99项ICU活动中的184种潜在失效。然后，以90%的可靠性（RPN≥100），确定医院A中有18项失效、医院B中有42项失效为不可接受风险，随后通过ECM分析其原因。
应用改进的过程失效模式与效应分析（PFMEA）来提高两家不同类型医院中选定的两个ICU的流程可靠性表明，该方法使工作人员能够识别、评估、确定潜在失效模式的优先级并进行分析，还使他们渴望找出其原因、推荐纠正措施，甚至参与流程改进，而不会感到受到高层管理人员的指责。此外，通过将FMEA和ECM相结合，团队成员可以从医疗保健角度轻松识别失效原因。
