Birkeli Gørill Helen, Thomas Owen Matthew Truscott, Deilkås Ellen Catharina Tveter, Ballangrud Randi, Lindahl Anne Karin
Division of Surgery, Akershus University Hospital, Nordbyhagen, Norway
Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo Faculty of Medicine, Oslo, Norway.
BMJ Open Qual. 2024 Oct 2;13(4):e002964. doi: 10.1136/bmjoq-2024-002964.
Hospitals should adopt multiple methods to monitor incidents for a comprehensive review of the types of incidents that occur. Contrary to traditional incident reporting systems, the Green Cross (GC) method is a simple visual method to recognise incidents based on teamwork and safety briefings. Its longitudinal effect on patient safety culture has not been previously assessed. This study aimed to explore whether the implementation of the GC method in a postanaesthesia care unit changed nurses' perceptions of different factors associated with patient safety culture over 4 years.
A longitudinal quasi-experimental pre-post intervention design with a comparison group was used. The intervention unit and the comparison group, which consisted of nurses, were recruited from the surgical department of a Norwegian university hospital. The intervention unit implemented the GC method in February 2019. Both groups responded to the staff survey before and then annually between 2019 and 2022 on the factors 'work engagement', 'teamwork climate' and 'safety climate'. The data were analysed using logistic regression models.
Within the intervention unit, relative to the changes in the comparison group, the results indicated significant large positive changes in all factor scores in 2019, no changes in 2020, significant large positive changes in 'work engagement' and 'safety climate' scores in 2021 and a significant medium positive change in 'work engagement' in 2022. At baseline, the comparison group had a significantly lower score in 'safety climate' than the intervention unit, but no significant baseline differences were found between the groups regarding 'work engagement' and 'teamwork climate'.
The results suggest that the GC method had a positive effect on the nurses' perception of factors associated with patient safety culture over a period of 4 years. The positive effect was completely sustained in 'work engagement' but was somewhat less persistent in 'teamwork climate' and 'safety climate'.
医院应采用多种方法监测事件，以便对所发生的事件类型进行全面审查。与传统的事件报告系统不同，绿十字（GC）方法是一种基于团队合作和安全简报来识别事件的简单直观方法。此前尚未评估其对患者安全文化的长期影响。本研究旨在探讨在麻醉后护理单元实施GC方法是否会在4年内改变护士对与患者安全文化相关的不同因素的认知。
采用纵向准实验性干预前后设计，并设置对照组。干预组和对照组由挪威一家大学医院外科的护士组成。干预组于2019年2月实施GC方法。两组在2019年之前以及2019年至2022年期间每年就“工作投入”“团队合作氛围”和“安全氛围”等因素进行员工调查。数据采用逻辑回归模型进行分析。
在干预组中，相对于对照组的变化，结果显示2019年所有因素得分均有显著的大幅正向变化，2020年无变化，2021年“工作投入”和“安全氛围”得分有显著的大幅正向变化，2022年“工作投入”有显著的中等程度正向变化。在基线时，对照组的“安全氛围”得分显著低于干预组，但在“工作投入”和“团队合作氛围”方面，两组之间未发现显著的基线差异。
结果表明，GC方法在4年期间对护士对与患者安全文化相关因素的认知产生了积极影响。这种积极影响在“工作投入”方面完全持续存在，但在“团队合作氛围”和“安全氛围”方面的持续性稍弱。
