临床科室学习氛围和患者安全氛围与住院医师患者安全行为的关系。

The Relationship Between the Learning and Patient Safety Climates of Clinical Departments and Residents' Patient Safety Behaviors.

机构信息

M.E.W.M. Silkens is scientific researcher, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands. O.A. Arah is professor, Department of Epidemiology, Fielding School of Public Health, and faculty associate, Center for Health Policy Research, University of California, Los Angeles, Los Angeles, California. C. Wagner is executive director, The Netherlands Institute for Health Services Research, Utrecht, the Netherlands, and professor in patient safety, VU Medical Center, Amsterdam, the Netherlands. A.J.J.A. Scherpbier is professor, Department of Educational Development and Research, and dean, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands. M.J. Heineman is professor, Department of Obstetrics and Gynecology, Academic Medical Center, and vice dean, Faculty of Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.

出版信息

Acad Med. 2018 Sep;93(9):1374-1380. doi: 10.1097/ACM.0000000000002286.

DOI:10.1097/ACM.0000000000002286

PMID:29771691

Abstract

PURPOSE

Improving residents' patient safety behavior should be a priority in graduate medical education to ensure the safety of current and future patients. Supportive learning and patient safety climates may foster this behavior. This study examined the extent to which residents' self-reported patient safety behavior can be explained by the learning climate and patient safety climate of their clinical departments.

METHOD

The authors collected learning climate data from clinical departments in the Netherlands that used the web-based Dutch Residency Educational Climate Test between September 2015 and October 2016. They also gathered data on those departments' patient safety climate and on residents' self-reported patient safety behavior. They used generalized linear mixed models and multivariate general linear models to test for associations in the data.

RESULTS

In total, 1,006 residents evaluated 143 departments in 31 teaching hospitals. Departments' patient safety climate was associated with residents' overall self-reported patient safety behavior (regression coefficient [b] = 0.33; 95% confidence interval [CI] = 0.14 to 0.52). Departments' learning climate was not associated with residents' patient safety behavior (b = 0.01; 95% CI = -0.17 to 0.19), although it was with their patient safety climate (b = 0.73; 95% CI = 0.69 to 0.77).

CONCLUSIONS

Departments should focus on establishing a supportive patient safety climate to improve residents' patient safety behavior. Building a supportive learning climate might help to improve the patient safety climate and, in turn, residents' patient safety behavior.

摘要

目的

在住院医师医学教育中，提高住院医师的患者安全行为应该是优先事项，以确保当前和未来患者的安全。支持性的学习和患者安全氛围可能会促进这种行为。本研究旨在考察住院医师自我报告的患者安全行为在多大程度上可以用其临床科室的学习氛围和患者安全氛围来解释。

方法

作者从荷兰使用基于网络的荷兰住院医师教育氛围测试的临床科室收集学习氛围数据，时间为 2015 年 9 月至 2016 年 10 月。他们还收集了这些科室的患者安全氛围以及住院医师自我报告的患者安全行为的数据。他们使用广义线性混合模型和多变量线性模型来检验数据中的关联。

结果

共有 1006 名住院医师评估了 31 家教学医院的 143 个科室。科室的患者安全氛围与住院医师整体自我报告的患者安全行为相关（回归系数[b]=0.33；95%置信区间[CI]=0.14 至 0.52）。科室的学习氛围与住院医师的患者安全行为无关（b=0.01；95%CI=-0.17 至 0.19），尽管它与患者安全氛围有关（b=0.73；95%CI=0.69 至 0.77）。