Rotteau Leahora, Goldman Joanne, Shojania Kaveh G, Vogus Timothy J, Christianson Marlys, Baker G Ross, Rowland Paula, Coffey Maitreya
Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
BMJ Qual Saf. 2022 Dec;31(12):867-877. doi: 10.1136/bmjqs-2021-013938. Epub 2022 Jun 1.
Healthcare leaders look to high-reliability organisations (HROs) for strategies to improve safety, despite questions about how to translate these strategies into practice. Weick and Sutcliffe describe five principles exhibited by HROs. Interventions aiming to foster these principles are common in healthcare; however, there have been few examinations of the perceptions of those who have planned or experienced these efforts.
This single-site qualitative study explores how healthcare professionals understand and enact the HRO principles in response to an HRO-inspired hospital-wide safety programme.
We interviewed 71 participants representing hospital executives, programme leadership, and staff and physicians from three clinical services. We observed and collected data from unit and hospital-wide quality and safety meetings and activities. We used thematic analysis to code and analyse the data.
Participants reported enactment of the HRO principles 'preoccupation with failure', 'reluctance to simplify interpretations' and 'sensitivity to operations', and described the programme as adding legitimacy, training, and support. However, the programme was more often targeted at, and taken up by, nurses compared with other groups. Participants were less able to identify interventions that supported the HRO principles 'commitment to resilience' and 'deference to expertise' and reported limited examples of changes in practices related to these principles. Moreover, we identified inconsistent, and even conflicting, understanding of concepts related to the HRO principles, often related to social and professional norms and practices. Finally, an individualised rather than systemic approach hindered collective actions underlying high reliability.
Our findings demonstrate that the safety programme supported some HRO principles more than others, and was targeted at, and perceived differently across professional groups leading to inconsistent understanding and enactments of the principles across the organisation. Combining HRO-inspired interventions with more targeted attention to each of the HRO principles could produce greater, more consistent high-reliability practices.
尽管对于如何将这些策略转化为实际行动存在疑问，但医疗保健领域的领导者仍期望从高可靠性组织（HROs）中获取提高安全性的策略。韦克和萨特克利夫描述了高可靠性组织所展现的五项原则。旨在培养这些原则的干预措施在医疗保健领域很常见；然而，对于那些规划或经历过这些努力的人的看法，却鲜有研究。
这项单中心定性研究探讨了医疗保健专业人员如何理解并践行高可靠性组织原则，以应对一项受高可靠性组织启发的全院安全计划。
我们采访了71名参与者，他们分别代表医院管理人员、项目负责人以及来自三个临床科室的工作人员和医生。我们观察并收集了科室及全院质量与安全会议及活动的数据。我们使用主题分析法对数据进行编码和分析。
参与者报告称践行了高可靠性组织原则中的“关注失败”“不愿简化解释”和“对运营敏感”，并将该计划描述为增加了合理性、培训和支持。然而，与其他群体相比，该计划更多地针对护士并被护士所接受。参与者较难确定支持高可靠性组织原则“致力于恢复力”和“尊重专业知识”的干预措施，并报告称与这些原则相关的实践变化实例有限。此外，我们发现对于与高可靠性组织原则相关的概念存在不一致甚至相互冲突的理解，这通常与社会和专业规范及实践有关。最后，个体化而非系统性的方法阻碍了实现高可靠性所需的集体行动。
我们的研究结果表明，安全计划对某些高可靠性组织原则的支持多于其他原则，并且针对不同专业群体，其被接受程度和认知也有所不同，导致整个组织对这些原则的理解和践行不一致。将受高可靠性组织启发的干预措施与对每项高可靠性组织原则更具针对性的关注相结合，可能会产生更广泛、更一致的高可靠性实践。
