在大型综合医疗保健系统中实施高可靠性组织框架:一个前后准实验性质量改进项目
Aaron M Sawyer1, Sreedevi Thiyarajan2, Keith Essen1
1Cognosante, LLC Contractor Support to the Veterans Health Administration (VHA), Falls Church, VA 22042, USA.
Military medicine
|November 2, 2024
概括
实施高可靠性组织 (HRO) 框架改善了退伍军人卫生管理局 (VHA) 设施的患者安全文化和报告. 这项质量改进项目在风险识别和错误透明度方面显示出积极的趋势.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 患者安全研究 患者安全研究
- 医疗保健中的组织行为
背景情况:
- 退伍军人卫生管理局 (VHA) 在其设施中实施了高可靠性组织 (HRO) 框架.
- 该倡议旨在提高综合卫生系统内的患者安全和质量.
研究的目的:
- 评估一个企业范围的高可靠性组织 (HRO) 框架实施的结果.
- 评估VHA设施内患者安全文化和报告数据的变化.
主要方法:
- 一个准实验性设计,使用来自139个VHA设施 (2019-2023) 的前后数据.
- 数据来源包括患者安全文化 (PSC) 调查和联合患者安全报告系统.
- 干预措施包括培训,指导,评估和体验式学习,在三个队伍中分阶段实施.
主要成果:
- 在所有设施中观察到PSC得分的广泛积极趋势.
- 在PSC第2维度 (风险识别和正义文化) 和第4维度 (错误透明度和风险减轻) 中发现了显著的改进.
- 增加了患者安全事件和临近呼叫报告,并增加了临近呼叫与不良事件的比率,特别是在第1组中.
结论:
- HRO框架的实施对VHA内的患者安全文化和报告产生了积极的影响.
- 这些发现将指导未来对VHA中HRO原则的改进,并为其他卫生系统的类似大规模质量改进工作提供信息.
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