Why is patient safety so hard? A selective review of ethnographic studies
Why is patient safety so hard? A selective review of ethnographic studies
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DOI：
10.1258/jhsrp.2009.009041
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发表时间：
2010-01-01
影响因子：
2.4
通讯作者：
Dixon-Woods, Mary
中科院分区：
文献类型：
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作者：
Dixon-Woods, Mary
人种学研究在研究患者安全方面很有价值。这是一个叙述性审查的四份报告的人种学研究的患者安全性在英国医院进行的患者安全性研究计划的一部分。其中三项研究是在手术室进行的，一项是在急症室进行的。研究发现，医院很少以确保完美的表现为目标。为支持完成任务所需的大量相互依赖的进程和资源的协调和调动很少是最佳的。这产生了巨大的压力，员工们通过制定各种补偿策略学会了忍受。团队合作和专业人员之间的沟通并不总是能够很好地发挥作用，以确保基本的程序信息得到分享或所需的活动顺序得到规划。工作人员并不总是做正确的事情，原因多种多样，包括对什么是正确的事情的争论。权力结构和问责制并不总是明确或运作良好。患者安全事件通常没有报告，尽管有许多不同的原因。可以得出结论，确保患者安全是困难的。对安全有多种相互作用的影响，解决方案需要基于对问题性质的正确理解，以及哪些方法可能最适合解决这些问题。一些看起来有吸引力和直截了当的解决方案可能会失败。解决安全问题需要承认，病人的安全不仅仅是一个技术问题，而是一个组织和专业政治的网站。
Ethnographic studies are valuable in studying patient safety. This is a narrative review of four reports of ethnographic studies of patient safety in UK hospitals conducted as part of the Patient Safety Research Programme. Three of these studies were undertaken in operating theatres and one in an A&E Department. The studies found that hospitals were rarely geared towards ensuring perfect performances. The coordination and mobilization of the large number of inter-dependent processes and resources needed to support the achievement of tasks was rarely optimal. This produced significant strain that staff learned to tolerate by developing various compensatory strategies. Teamwork and inter-professional communication did not always function sufficiently well to ensure that basic procedural information was shared or that the required sequence of events was planned. Staff did not always do the right things, for a wide range of different reasons, including contestations about what counted as the right thing. Structures of authority, and accountability were not always clear or well-functioning. Patient safety incidents were usually not reported, though there were many different reasons for this. It can be concluded that securing patient safety is hard. There are multiple interacting influences on safety, and solutions need to be based on a sound understanding of the nature of the problems and which approaches are likely to be best suited to resolving them. Some solutions that appear attractive and straightforward are likely to founder. Addressing safety problems requires acknowledgement that patient safety is not simply a technical issue, but a site of organizational and professional politics.