一项定性正偏离研究，旨在探索老年人医疗病房中卓越的安全护理。
A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people.
机构信息
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
Cancer Research Division, Cancer Council, Sydney, New South Wales, Australia.
出版信息
BMJ Qual Saf. 2019 Aug;28(8):618-626. doi: 10.1136/bmjqs-2018-008023. Epub 2019 Feb 13.
BACKGROUND
The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people.
METHODS
A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated 'positively deviant' patient care.
RESULTS
Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented.
CONCLUSION
This study exemplifies that there are no 'silver bullets' to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
背景
正向偏差方法旨在识别和学习那些表现出卓越绩效的人。本研究旨在探讨多学科团队如何在老年人医疗病房提供异常安全的护理。
方法
对四个正向偏差和四个略高于平均水平的匹配对照病房进行了定性的正向偏差研究，这些病房是使用常规收集的 NHS 安全温度计数据确定的。共有 70 名多学科工作人员参加了 8 个焦点小组，探讨了工作人员对团队如何提供安全患者护理的看法。主题分析分两个阶段进行：首先，确定在所有病房中促进安全的工具、流程、策略以及文化和社会背景；其次，生成有助于“正向偏差”患者护理的特征假设。
结果
基于正向偏差病房和对照病房之间可识别的定性差异，假设了 14 个特征有助于老年人医疗病房提供异常安全的护理。本文探讨了医疗保健专业人员认为最突出的五个正向偏差特征。其中包括团队合作的关系方面，特别是关于员工相互了解并在真正整合的多学科团队中一起工作。正向偏差病房的文化和社会背景被认为会影响实用工具（例如，安全简报和床边板）的实施方式。
结论
本研究证明，在老年人医疗病房实现异常安全的患者护理没有“灵丹妙药”。医疗保健领导者应鼓励真正整合的多学科病房团队，让员工相互了解并作为一个团队工作。关注这些基本特征可能会促进广泛的安全结果的卓越表现。
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