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医疗保健专业人员与患者共同设计并验证一种机制,用于服务使用者在护理转接后反馈患者安全体验:一项定性研究。

Healthcare professional and patient codesign and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study.

作者信息

Scott Jason, Heavey Emily, Waring Justin, Jones Diana, Dawson Pamela

机构信息

Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.

Social Policy Research Unit, York University, York, UK.

出版信息

BMJ Open. 2016 Jul 12;6(7):e011222. doi: 10.1136/bmjopen-2016-011222.

Abstract

OBJECTIVE

To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations.

DESIGN

Qualitative study using participatory methods (codesign workshops) and cognitive interviews. Workshop data were analysed concurrently with participants, and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism.

PARTICIPANTS

Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in 2 workshops. Workshop 1 explored principles underpinning safety feedback mechanisms, and workshop 2 included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients.

RESULTS

Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across 3 stages of the care transfer: departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer.

CONCLUSIONS

Participatory, codesign principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey's usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers.

摘要

目的

开发并验证一种机制,以便患者能够就组织间护理转接后的安全体验提供反馈。

设计

采用参与式方法(协同设计研讨会)和认知访谈的定性研究。研讨会数据与参与者同步进行分析,认知访谈采用基于所开发反馈机制的演绎法进行主题分析。

参与者

有目的地招募了5名专家患者和11名医疗保健专业人员,在2次研讨会上开发反馈机制。研讨会1探讨了安全反馈机制的基本原则,研讨会2包括反馈机制的实际开发。反馈机制(一项安全调查)的最终设计和内容由研讨会参与者进行了验证,并对患者进行了28次认知访谈。

结果

研讨会参与者确定,安全反馈机制应以患者为中心,简短明了,明确指示如何完成,可选择匿名,且在积极(安全)和消极(不安全)体验之间保持平衡。商定的反馈机制包括一项在护理转接的3个阶段(出发、途中和到达)进行的调查。跨组织边界的护理被认为很复杂,医疗保健专业人员承认实施影响其他组织的变革存在困难。认知访谈参与者认为调查内容相关,但指出了与调查格式和对护理转接的理解有关的完成障碍。

结论

在开发安全调查时,参与式协同设计原则有助于克服护理转接复杂环境中对安全理解的差异。确定了该调查在可用性和患者可接受性方面的实际障碍,从而对调查设计进行了修改。需要进一步研究以确定该调查对患者和医疗保健专业人员的可用性和可接受性,以及确定治理结构在涉及多个医疗或社会护理提供者时应如何接纳患者反馈。

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