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超越合规:对手术安全检查清单实践的定性研究
Shu Rong Lim1, Qin Xiang Ng2, Xiaohui Xin1
1Health Services Research Unit, Singapore General Hospital, Singapore.
Social science & medicine (1982)
|February 16, 2024
概括
世界卫生组织的外科安全检查清单 (SSC) 可以成为一种仪式,破坏患者的安全. 专注于彻底性,效率和协作文化是最大限度地发挥SSC的关键.
科学领域:
- 医疗保健的质量和安全
- 手术患者护理手术患者护理
- 医学中的组织行为.
背景情况:
- 世界卫生组织的外科安全检查清单 (SSC) 旨在改善团队沟通和患者安全,作为对关键错误的防御.
- 之前的努力集中在检查清单遵守,但了解影响SSC实践变化的社会心理因素至关重要.
- 本研究研究了SSC在重新实施倡议后的实际应用.
研究的目的:
- 进行二次定性分析操作室 (OT) 关于SSC使用的观察笔记.
- 探索SSC实践变化背后的行为模式和社会心理机制.
- 超越简单的合规评估,了解SSC实施的细微差别.
主要方法:
- 在新加坡一家三级医院对13个学科的外科手术过程中的109个观察笔记进行了定性分析.
- 数据是在SSC重新实施后三个月收集的,并使用反射主题分析进行分析.
- 诱导编码来识别主题,然后使用默顿的社会偏差理论进行解释.
主要成果:
- 确定了两种类型的SSC实践:寻求安全的行动 (类型 1) 和仪式性的行动 (类型 2).
- 寻求安全的做法以彻底性,奉献精神和积极的安全沟通为特征.
- 仪式主义的做法包括忙,遗漏,委托,分心和缺乏安全声音.
结论:
- 对SSC的仪式性坚持可能会危及外科安全,并增加从未发生的风险.
- 完善与效率之间的平衡对于SSC的有效使用至关重要.
- 培养合作和团队合作的文化对于加强外科安全至关重要.
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