Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK.
Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
BMC Health Serv Res. 2020 Apr 17;20(1):324. doi: 10.1186/s12913-020-05208-3.
Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.
Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.
Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care 'resilience' training of health care professionals were factors used to develop RHC.
Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
传统的医疗保健安全管理方法主要侧重于计数错误和了解事情出错的方式。弹性医疗保健（RHC）提供了一种从事件中学习和了解大多数情况下工作安全性的替代互补视角。本研究的目的是确定 RHC 在已发表文献中是如何概念化、描述和解释的，描述研究 RHC 所使用的方法，并确定发展 RHC 的因素。
对 PubMed、Scopus 和 Cochrane 数据库进行电子检索，以确定相关的同行评议研究，并对手头的书籍进行手工搜索，以解释 RHC 作为一个概念是如何被解释的，研究它使用了哪些方法，以及哪些因素对其发展很重要。由两名研究人员独立评估研究。使用主题方法对数据进行综合。
共纳入 36 项研究；它们对 RHC 的描述相似，即调整其功能的能力，在事件之前、期间或之后，从而在预期和意外条件下维持所需的操作。主要使用定性方法来研究 RHC。两种类型的数据来源已被使用：直接（例如焦点小组和调查）和间接（例如观察和模拟）数据来源。大多数用于研究 RHC 的工具都是基于预先定义的弹性结构开发的，并分为三类：绩效变异性和工作完成情况、弹性的基石能力，以及与其他安全管理范式的整合。目前已经存在用于研究 RHC 的工具，但尚未完全实施。有效的团队关系、权衡以及医疗保健专业人员的“弹性”培训是发展 RHC 的因素。
尽管 RHC 的概念化、研究方法和发展因素存在一致性，但在确定研究 RHC 的金标准策略之前，仍有几个问题需要回答。这些问题包括在多层次和多样化的环境中实施 RHC 评估方法，以及制定、测试和评估干预措施，以解决组织和机构变革中 RHC 带来的更广泛的安全影响。
