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中国孝感市县级医院外科的患者安全文化与其他科室相比如何?

How Does Patient Safety Culture in the Surgical Departments Compare to the Rest of the County Hospitals in Xiaogan City of China?

作者信息

Wang Manli, Tao Hongbing

机构信息

Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, China.

出版信息

Int J Environ Res Public Health. 2017 Sep 26;14(10):1123. doi: 10.3390/ijerph14101123.

Abstract

: Patient safety culture affects patient safety and the performance of hospitals. The Hospital Survey on Patient Safety Culture (HSOPSC) is generally used to assess the safety culture in hospitals and unit levels. However, only a few studies in China have measured surgical settings compared with other units in county hospitals using the HSOPSC. This study aims to assess the strengths and weaknesses of surgical departments compared with all other departments in county hospitals in China with HSOPSC. : This research is a cross-sectional study. : In 2015, a Chinese translation of HSOPSC was administered to 1379 staff from sampled departments from 19 county hospitals in Xiaogan City (Hubei Province, China) using a simple random and cluster sampling method. : The HSOPSC was completed by 1379 participants. The percent positive ratings (PPRs) of 12 dimensions (i.e., teamwork within units, organizational learning and continuous improvement, staffing, non-punitive response to errors, supervisor/ manager expectations and actions promoting patient safety, feedback and communication about errors, communication openness, hospital handoffs and transitions, teamwork across hospital units, hospital management support for patient safety, overall perception of safety, as well as frequency of events reported) and the positive proportion of outcome variables (patient safety grade and number of events reported) between surgical departments and other departments were compared with -tests and X² tests, respectively. A multiple regression analysis was conducted, with the outcome dimensions serving as dependent variables and basic characteristics and other dimensions serving as independent variables. Similarly, ordinal logistic regression was used to explore the influencing factors of two categorical outcomes. : A total of 56.49% of respondents were from surgical departments. The PPRs for "teamwork within units" and "organizational learning and continuous improvement" were ≥75%, which denoted strengths, and the PPRs for "staffing" and "non-punitive response to errors" were ≤50%, which denoted weaknesses in surgical units and other units. Three dimensions for surgical departments were weaker than those for other departments ( < 0.05). The staff from surgical units reported more events compared with the other units, but only a few respondents in surgical settings evaluated patient safety grade as good/excellent. Four dimensions influenced patient safety grade, and three dimensions influenced event reporting in surgical units. : Strategies including recruiting workers, using the reporting system, and building a non-punitive culture should be adopted in the surgical units of county hospitals in China to improve safety culture. Supervisors should also prioritise patient safety.

摘要

患者安全文化影响患者安全和医院绩效。医院患者安全文化调查(HSOPSC)通常用于评估医院及科室层面的安全文化。然而,在中国,仅有少数研究使用HSOPSC对县级医院手术科室与其他科室的安全文化进行测评。本研究旨在运用HSOPSC评估中国县级医院手术科室相较于其他科室的优势与不足。

本研究为横断面研究。

2015年,采用简单随机整群抽样方法,对中国湖北省孝感市19家县级医院抽样科室的1379名员工进行了HSOPSC中文版调查。

1379名参与者完成了HSOPSC调查。采用t检验和卡方检验分别比较了手术科室与其他科室在12个维度(即科室内部团队合作、组织学习与持续改进、人员配备、对差错的无惩罚性反应、主管/经理对促进患者安全的期望与行动、差错的反馈与沟通、沟通开放性、医院交接与过渡、跨科室团队合作、医院管理对患者安全的支持、对安全的总体认知以及事件报告频率)的阳性评分百分比(PPRs)以及结局变量(患者安全等级和事件报告数量)的阳性比例。进行多元回归分析,将结局维度作为因变量,基本特征和其他维度作为自变量。同样,采用有序逻辑回归探索两个分类结局的影响因素。

共有56.49%的受访者来自手术科室。“科室内部团队合作”和“组织学习与持续改进”的PPRs≥75%,表明具有优势;“人员配备”和“对差错的无惩罚性反应”的PPRs≤50%,表明手术科室和其他科室存在不足。手术科室的三个维度弱于其他科室(P<0.05)。与其他科室相比,手术科室的员工报告的事件更多,但手术科室中只有少数受访者将患者安全等级评为良好/优秀。四个维度影响手术科室的患者安全等级,三个维度影响事件报告。

中国县级医院的手术科室应采取包括招聘员工、使用报告系统和建立无惩罚性文化等策略来改善安全文化。主管也应将患者安全作为优先事项。

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