Department of Paediatrics, Region Jönköping County, 55185, Jönköping, SE, Sweden.
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
BMC Health Serv Res. 2022 Aug 30;22(1):1101. doi: 10.1186/s12913-022-08462-9.
To reduce patient harm, healthcare has focused on improvement based on learning from errors and adverse events (Safety-I). Daily huddles with staff are used to support incident reporting and learning in healthcare. It is proposed that learning for improvement should also be based on situations where work goes well (Safety-II); daily safety huddles should also reflect this approach. A Safety-II-inspired model for safety huddles was developed and implemented at the Neonatal Care Unit at a regional hospital in Sweden. This study followed the implementation with the research questions: Do patient safety huddles with a focus on Safety-II affect the results of measurements of the patient safety culture? What are the experiences of these huddles amongst staff? What experiences of everyday work arise in the patient safety huddles?
A multi-method approach was used. The quantitative part consisted of a questionnaire (151 items), submitted on four different occasions, and analysed using Mann Whitney U-test and Kruskal Wallis ANOVA-test. The qualitative data were analysed using thematic content analyses of interviews with staff (n = 14), as well as answers to open questions in the questionnaires.
There were 151 individual responses to the questionnaires. The response rates were 44% to 59%. For most comparisons, there were no differences. There were minor changes in patient safety culture measurements. A lower rating was found in December 2020, compared to October 2019 (p < 0.05), regarding whether the employees pointed out when something was about to go wrong. The interviews revealed that, even though most respondents were generally positive towards the huddles (supporting factors), there were problems (hindering factors) in introducing Safety-II concepts in daily safety huddles. There was a challenge to understanding and describing things that go well.
For patient safety huddles aimed at exploring everyday work to be experienced as a base for learning, including both negative and positive events (Safety-II); there is a need for an open and permissive climate, that all professions participate and stable conditions in management. Support from managers and knowledge of the underpinning Safety-II theories of those who lead the huddles, may also be of importance.
为了减少患者伤害，医疗保健已将重点放在从错误和不良事件中学习（安全 I）的改进上。每天与员工进行的小组讨论用于支持医疗保健中的事件报告和学习。有人提出，改进学习也应基于工作顺利进行的情况（安全 II）；每日安全小组讨论也应反映这种方法。在瑞典一家地区医院的新生儿护理病房开发并实施了一种受安全 II 启发的安全小组讨论模型。本研究在实施后提出了以下研究问题：以安全 II 为重点的患者安全小组讨论是否会影响患者安全文化测量结果？员工对这些小组讨论有何体验？在患者安全小组讨论中出现了哪些日常工作经验？
采用多方法方法。定量部分由问卷（151 项）组成，分四次提交，并使用曼惠特尼 U 检验和克鲁斯卡尔-沃利斯 ANOVA 检验进行分析。定性数据通过对员工访谈（n=14）以及问卷中的开放式问题的回答进行主题内容分析进行分析。
共收到 151 份个人问卷回复。回复率为 44%至 59%。对于大多数比较，没有差异。患者安全文化测量有一些细微的变化。与 2019 年 10 月相比，2020 年 12 月员工指出即将出现问题的频率较低（p<0.05）。访谈显示，尽管大多数受访者普遍对小组讨论持积极态度（支持因素），但在日常安全小组讨论中引入安全 II 概念存在问题（阻碍因素）。理解和描述顺利进行的事情存在挑战。
对于旨在探索日常工作以作为学习基础的患者安全小组讨论（包括负面和正面事件），需要开放和宽容的氛围，所有专业人员都参与其中，管理层的条件稳定。管理人员的支持以及负责领导小组讨论的人员对安全 II 理论的了解，也可能很重要。
