Lorenzini Elisiane, Oelke Nelly D, Marck Patricia Beryl, Dall'agnol Clarice Maria
Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Rua São Manoel, 963, Bairro Rio Branco, Porto Alegre, RS, Brazil.
Interior Health Regional SPOR Support Centre, School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada.
Int J Qual Health Care. 2017 Oct 1;29(5):745-749. doi: 10.1093/intqhc/mzx080.
Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results. We propose a methodological approach for safety culture research, which integrates the theory and practice of restoration science with the principles and methods of deliberative dialogue to support active engagement in critical reflection and collective debate. Our aim is to describe how these two innovative approaches in health services research can be used together to provide a comprehensive effective method to study and implement change in safety culture. Restorative research in health care integrates socio-ecological theory of complex adaptive systems concepts with collaborative, place-sensitive study of local practice contexts. Deliberative dialogue brings together all stakeholders to collectively develop solutions on an issue to facilitate change. Together these approaches can be used to actively engage people in the study of safety culture to gain a better understanding of its elements. More importantly, we argue that the synergistic use of these approaches offers enhanced potential to move health care professionals towards actionable strategies to improve patient safety within today's complex health care systems.
安全文化是患者安全的关键组成部分。医疗保健领域的许多患者安全策略都借鉴了航空等高可靠性组织（HRO）的经验。然而，迄今为止，通过高可靠性组织方法来转变医疗保健机构文化的尝试结果喜忧参半。我们提出了一种安全文化研究的方法，该方法将恢复科学的理论与实践与审议对话的原则和方法相结合，以支持积极参与批判性反思和集体辩论。我们的目的是描述如何将卫生服务研究中的这两种创新方法结合起来，以提供一种全面有效的方法来研究和实施安全文化变革。医疗保健领域的恢复性研究将复杂适应系统概念的社会生态理论与对当地实践环境的协作式、因地制宜的研究相结合。审议对话将所有利益相关者聚集在一起，共同就一个问题制定解决方案以促进变革。这些方法可以共同用于促使人们积极参与安全文化研究，以更好地理解其要素。更重要的是，我们认为这些方法的协同使用具有更大的潜力，能够推动医疗保健专业人员在当今复杂的医疗保健系统中采取可行动的策略来提高患者安全。
