Vikan Magnhild, Deilkås Ellen Ct, Valeberg Berit T, Bjørnnes Ann K, Husby Vigdis S, Haugen Arvid S, Danielsen Stein O
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway.
Patient Saf Surg. 2024 Feb 19;18(1):7. doi: 10.1186/s13037-024-00389-w.
In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department.
This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes.
The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning.
This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
尽管全球都在实施手术安全检查表以提高患者安全，但接受手术的患者仍极易面临潜在可预防并发症和不良后果的高风险。本研究旨在探讨手术团队对患者安全文化的看法，了解他们对不良事件风险的认知，并确定手术科室质量改进的关注主题。
本定性研究采用探索性设计和归纳法。在2023年1月10日至2023年5月11日期间进行了个体半结构化深度访谈。参与者包括手术团队成员（n = 17）、普通外科和骨科医生（n = 5）、麻醉医生（n = 4）、麻醉护士（n = 4）和手术室护士（n = 4）。从挪威两家三级医院的普通外科和骨科手术团队中有意招募中层管理人员，旨在因性别、年龄和专业年限实现最大程度的差异。按照布劳恩和克拉克的反思性主题分析方法对数据材料进行分析，以生成意义模式并形成主题和子主题。
分析过程产生了三个主题，描述了参与者对手术环境中患者安全文化的看法：（1）个人问责作为安全保障，（2）心理安全作为手术室中促进健康和安全表现的催化剂，（3）积极结构和参与组织学习的重要性。
本研究为手术环境中的患者安全文化提供了实证见解。该研究强调了支持个人能力、在手术团队中建立心理安全以及创建促进学习型组织的结构和文化的重要性。包括基于这些结果进行干预的质量改进项目，可能会增强手术环境中的患者安全文化并减少不良事件的发生频率。
