Churruca Kate, Ellis Louise A, Braithwaite Jeffrey
Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
BMC Health Serv Res. 2018 Mar 22;18(1):201. doi: 10.1186/s12913-018-3012-2.
Research in criminology and social-psychology supports the idea that visible signs of disorder, both physical and social, may perpetuate further disorder, leading to neighborhood incivilities, petty violations, and potentially criminal behavior. This theory of 'broken windows' has now also been applied to more enclosed environments, such as organizations.
This paper debates whether the premise of broken windows theory, and the concept of 'disorder', might also have utility in the context of health services. There is already a body of work on system migration, which suggests a role for violations and workarounds in normalizing unwarranted deviations from safe practices in healthcare organizations. Studies of visible disorder may be needed in healthcare, where the risks of norm violations and disorderly environments, and potential for harm to patients, are considerable. Everyday adjustments and flexibility is mostly beneficial, but in this paper, we ask: how might deviations from the norm escalate from necessary workarounds to risky violations in care settings? Does physical or social disorder in healthcare contexts perpetuate further disorder, leading to downstream effects, including increased risk of harm to patients?
We advance a model of broken windows in healthcare, and a proposal to study this phenomenon.
犯罪学和社会心理学的研究支持这样一种观点，即无论是物理上的还是社会层面的无序迹象，都可能使进一步的无序持续存在，导致邻里不文明行为、轻微违规行为以及潜在的犯罪行为。这种“破窗理论”如今也已应用于更封闭的环境，如组织。
本文探讨了破窗理论的前提以及“无序”概念在医疗服务背景下是否也具有实用性。已有一系列关于系统迁移的研究，这些研究表明违规行为和变通方法在使医疗组织中偏离安全规范的无端偏差常态化方面发挥了作用。在医疗领域，可能需要对明显的无序进行研究，因为违反规范和无序环境的风险以及对患者造成伤害的可能性都相当大。日常的调整和灵活性大多是有益的，但在本文中，我们要问：在护理环境中，偏离规范是如何从必要的变通方法升级为危险的违规行为的？医疗环境中的物理或社会无序是否会使进一步的无序持续存在，从而导致包括患者受伤害风险增加在内的下游效应？
我们提出了一个医疗领域的破窗模型以及一项研究这一现象的提议。
