Jt Comm J Qual Patient Saf. 2021 Aug;47(8):526-532. doi: 10.1016/j.jcjq.2021.03.006. Epub 2021 Mar 13.
Current safety efforts in health care use Safety I (find and fix), which has benefits and shortcomings. Safety leaders in multiple industries realize that complex adaptive systems require a new approach-Safety II (proactive safety). Our goal was to develop practical, usable tools to spread Safety II and resilience engineering competencies to clinical frontline staff. Using our prior research and Plan-Do-Study-Act cycles, we developed tools to enhance Safety II competencies that individuals with various backgrounds could understand. Tools address recognizing (Pause to Predict), responding (IDEA), and learning (Feed Forward). These are being taught organizationally in a unit-by-unit sequence. Use of these tools is expected to prompt a shift toward a more proactive mental model of safety that we want our frontline providers to adopt. Coordinating the expertise of bedside clinicians during unprecedented events can safely expand the boundaries of conditions under which we can provide high-quality care by increasing individuals' and subsequently our systems' adaptive capacity. We believe this is the first work describing attempts to operationalize Safety II concepts broadly in a health care organization.
目前医疗保健领域的安全工作采用的是安全 I（发现和修复），它有其优点和缺点。多个行业的安全领导者意识到，复杂适应系统需要一种新的方法——安全 II（主动安全）。我们的目标是开发实用、可用的工具，将安全 II 和弹性工程能力传播到临床一线员工。我们利用之前的研究和计划-执行-研究-行动循环，开发了工具来增强安全 II 能力，使具有不同背景的个人都能够理解。这些工具涉及识别（暂停预测）、响应（IDEA）和学习（前馈）。这些工具正在按单元顺序在组织中进行教学。预计这些工具的使用将促使人们转向更主动的安全思维模式，我们希望我们的一线服务提供者能够采用这种模式。在前所未有的事件中协调床边临床医生的专业知识，可以通过提高个人和我们系统的适应能力，安全地扩大我们能够提供高质量护理的条件范围。我们相信，这是第一篇描述在医疗保健组织中广泛实施安全 II 概念的尝试的文章。
