Birkeli Gørill, Deilkås Ellen Catharina Tveter, Ballangrud Randi, Lindahl Anne Karin
Division of Surgery, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
Department of Health Management and Health Economics, University of Oslo Faculty of Medicine, Institute of Health and Society, Forskningsveien 3A, 0373, Oslo, Norway.
BMC Health Serv Res. 2025 Apr 2;25(1):493. doi: 10.1186/s12913-025-12626-8.
Prevailing efforts to ensure patient safety have primarily focused on learning from errors and adverse events (Safety-I). However, it is advocated that complex systems also learn from success (Safety-II) and focus on healthcare professionals' well-being at work to increase resilience. Learning from Excellence is a British initiative designed to learn from successful practices and provide positive feedback to the staff. It has gained enthusiastic followers in several countries, including Norway. However, how it influences learning, well-being and quality improvement, has not been studied in-depth. This study intends to address these gaps. Thus, this study aimed to describe healthcare professionals' experiences with Learning from Excellence six months after its implementation in a postanaesthesia care unit.
A qualitative descriptive design was applied. Learning from Excellence was implemented in a postanaesthesia care unit of a Norwegian university hospital between November 2022 and May 2023. Six semi-structured focus group interviews were conducted, from May to June 2023, with a convenience sample of nurses (n = 17) and physicians (n = 7). The data were analysed through inductive reflexive thematic analysis. The study adhered to the COREQ guidelines.
This study reports four prominent themes encapsulating healthcare professionals' experiences with Learning from Excellence. These themes were termed as follows: 1) 'Facilitates a more positive working climate', including sub-themes 'Helps spread positive feedback' and 'Feeling seen and motivated'; 2) 'Why don't I get any 'likes'?'; 3) 'Organisational learning is challenging', including sub-themes 'Hesitating to report' and 'Provides mostly superficial learning'; and 4) 'Success inspires quality improvement project'.
Implementing LfE mostly contributed to a positive working climate in a postanaesthesia care unit. For LfE to be worth implementing, it is essential to improve organisational learning, while minimising the negative effects of LfE, such as exclusivity issues.
ClinicalTrials.gov NCT05794490; first registered on March 4, 2023.
当前确保患者安全的努力主要集中于从错误和不良事件中学习（安全-Ⅰ）。然而，有人主张复杂系统也应从成功中学习（安全-Ⅱ），并关注医护人员的工作幸福感以增强恢复力。“从卓越中学习”是一项英国倡议，旨在从成功实践中学习并向员工提供积极反馈。它在包括挪威在内的几个国家赢得了热情的追随者。然而，其如何影响学习、幸福感和质量改进尚未得到深入研究。本研究旨在填补这些空白。因此，本研究旨在描述在麻醉后护理单元实施“从卓越中学习”六个月后医护人员的体验。
采用定性描述性设计。2022年11月至2023年5月期间，在挪威一家大学医院的麻醉后护理单元实施了“从卓越中学习”。2023年5月至6月，对护士（n = 17）和医生（n = 7）的便利样本进行了六次半结构化焦点小组访谈。通过归纳反思性主题分析对数据进行分析。本研究遵循COREQ指南。
本研究报告了四个突出主题，概括了医护人员对“从卓越中学习”的体验。这些主题如下：1）“营造更积极的工作氛围”，包括子主题“有助于传播积极反馈”和“感到被关注和有动力”；2）“为什么我没有得到任何‘赞’？”；3）“组织学习具有挑战性”，包括子主题“犹豫是否报告”和“大多提供表面学习”；4）“成功激发质量改进项目”。
实施“从卓越中学习”在很大程度上有助于在麻醉后护理单元营造积极的工作氛围。为使“从卓越中学习”值得实施，必须改进组织学习，同时尽量减少其负面影响，如排他性问题。
ClinicalTrials.gov NCT05794490；于2023年3月4日首次注册。
