Bethune Rob M, Ball Sue, Doran Natasha, Harris Michael, Medina-Lara Antionieta, Fornasiero Mauro, Hill Matt, Lang Iain, McGregor-Harper Judith, Sheaff Rod
Colorectal Surgery, Royal Exeter University Healthcare NHS Foundation Trust, Exeter, GBR.
National Institute for Health and Care Research (NIHR) Applied Research Collaboration, South West Peninsula (PenARC), University of Exeter Medical School, Exeter, GBR.
Cureus. 2023 Sep 3;15(9):e44603. doi: 10.7759/cureus.44603. eCollection 2023 Sep.
Objectives Safety culture surveys have been widely used in healthcare for more than two decades predominantly as a tool for measuring the level of safety culture (as defined as the beliefs and attitudes that staff express about how their organisation ought to work and how it does in fact work). However, there is the potential for the survey process itself to influence the safety culture and working practices in departments and organisations. The objective of this study was to identify the mechanism by which these changes might occur. Design, setting and participants Mixed methods combining qualitative semi-structured interviews and quantitative scores from patient safety surveys. This evaluation was conducted across general practice, community and acute hospitals in two NHS regions in England; South West and Greater Manchester. The study was undertaken between 2015 and 2018 during the implementation of a series of Patient Safety Collaboratives. Safety, Communication, Operational Reliability, and Engagement (SCORE) surveys were administered in 15 units, followed by a staff debriefing and a second SCORE survey. Semi-structured interviews were conducted with clinicians (n=61). Results from the first and second surveys were compared in order to test for differences in responses. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. Analysis and results Results from the first and second surveys were compared using chi-squared and Fisher's exact tests. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. There was little change in responses between the first and second SCORE surveys. Within general practice there was some improvement in responses in three survey domains; however, these differences were not conclusive. The qualitative interview data demonstrated a beneficial effect on safety culture. Staff stated that the survey debriefings created a new safe space where problems could be discussed and improvement plans created. Conclusions Safety culture surveys can improve safety culture within departments if they are followed by a process that includes debriefing the staff and working with them to develop improvement plans.
目标 二十多年来，安全文化调查在医疗保健领域得到了广泛应用，主要作为一种衡量安全文化水平的工具（安全文化被定义为员工对其组织应该如何运作以及实际如何运作所表达的信念和态度）。然而，调查过程本身有可能影响部门和组织中的安全文化及工作实践。本研究的目的是确定这些变化可能发生的机制。
设计、背景和参与者 采用定性半结构化访谈和患者安全调查定量评分相结合的混合方法。该评估在英格兰两个国民保健服务（NHS）地区的全科医疗、社区和急症医院进行；西南部和大曼彻斯特。该研究在2015年至2018年期间一系列患者安全协作项目实施过程中开展。对15个单位进行了安全、沟通、操作可靠性和参与度（SCORE）调查，随后进行了员工汇报和第二次SCORE调查。对61名临床医生进行了半结构化访谈。比较了第一次和第二次调查的结果以检验回答的差异。对参与单位进行了61次半结构化访谈并进行了主题分析。
分析与结果 采用卡方检验和费舍尔精确检验比较了第一次和第二次调查的结果。对参与单位进行了61次半结构化访谈并进行了主题分析。第一次和第二次SCORE调查的回答变化不大。在全科医疗中，三个调查领域的回答有一些改善；然而，这些差异并不具有决定性。定性访谈数据表明对安全文化有有益影响。员工表示，调查汇报创造了一个新的安全空间，在这个空间里可以讨论问题并制定改进计划。
结论 如果安全文化调查之后有一个包括向员工汇报并与他们合作制定改进计划的过程，那么安全文化调查可以改善部门内的安全文化。
