Campione Joanne, Famolaro Theresa
Jt Comm J Qual Patient Saf. 2018 Jan;44(1):23-32. doi: 10.1016/j.jcjq.2017.09.001. Epub 2017 Dec 2.
Patient safety culture has a positive influence on the effectiveness of patient safety and quality improvement interventions. A study was conducted to gain knowledge about promising best practices used by hospitals to improve patient safety culture hospitalwide.
Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS) Hospital Survey longitudinal results from 536 hospitals that submitted data to the Hospital SOPS database from 2007 to 2014 were analyzed. Composite-level and aggregate improvement was measured, resulting in the identification of "top-improving," large hospitals (400 + beds). Semistructured interviews were conducted with one to three interviewees (for example, Vice President of Clinical Quality, Patient Safety Officer, Chief Medical Officer) from six top-improving hospitals. The transcripts of the interviews were analyzed to identify common themes and best practices among the hospitals.
The mean change in the all-composite percent positive culture score was a 1.7 percentage point increase. The six hospitals interviewed had an average increase of 8.6 percentage points (range, 6.5-10.6) in their culture score. The three most common practices for improving culture as described by the hospital quality leaders from the six hospitals were (1) goal setting and strong action planning for quality improvement, (2) implementation of well-known patient safety initiatives and programs, and (3) rigorous survey administration methods.
Among six large hospitals that improved their hospitalwide culture score, the common best practices were the implementation of routine culture measurement with a wide dissemination of results, strong action planning for improvement that includes leadership support and involvement from all staff levels, and multifaceted patient safety programs and education.
患者安全文化对患者安全有效性及质量改进干预措施具有积极影响。开展了一项研究，以了解医院在全院范围内用于改善患者安全文化的有前景的最佳实践。
分析了医疗保健研究与质量局（AHRQ）患者安全文化调查（SOPS）的纵向结果，这些结果来自2007年至2014年向医院SOPS数据库提交数据的536家医院。对综合水平和总体改进情况进行了衡量，从而确定了“进步最大的”大型医院（400张及以上床位）。对六家进步最大的医院的一至三名受访者（例如临床质量副总裁、患者安全官、首席医疗官）进行了半结构化访谈。对访谈记录进行分析，以确定医院之间的共同主题和最佳实践。
所有综合积极文化得分的平均变化为提高了1.7个百分点。接受访谈的六家医院的文化得分平均提高了8.6个百分点（范围为6.5 - 10.6）。六家医院的医院质量负责人提到的改善文化的三种最常见做法是：（1）设定目标并制定强有力的质量改进行动计划；（2）实施知名的患者安全倡议和计划；（3）严格的调查管理方法。
在六家提高了全院文化得分的大型医院中，共同的最佳实践包括实施常规文化测量并广泛传播结果、制定强有力的改进行动计划，包括领导层的支持和各级员工的参与，以及多方面的患者安全计划和教育。
