The human factor: the critical importance of effective teamwork and communication in providing safe care
The human factor: the critical importance of effective teamwork and communication in providing safe care
复制标题
DOI：
10.1136/qshc.2004.010033
复制
发表时间：
2004-10-01
影响因子：
--
通讯作者：
Bonacum, D
中科院分区：
文献类型：
--
作者：
Leonard, M;Graham, S;Bonacum, D
有效的沟通和团队合作对于提供高质量、安全的患者护理至关重要。通信故障是意外患者伤害的一个非常常见的原因。医疗护理的复杂性，再加上人类表现的固有局限性，使得临床医生拥有标准化的沟通工具，创造一个个人可以说出并表达担忧的环境，并分享共同的“关键语言”以提醒团队成员注意不安全的情况至关重要。通常，有效的沟通取决于情况或个性。其他高可靠性领域，如商业航空，已经表明采用标准化的工具和行为是加强团队合作和降低风险的非常有效的策略。我们描述了我们正在进行的患者安全实施使用这种方法在凯撒Permanente，一个非营利性的美国医疗保健系统提供830万患者的护理。我们描述了具体的临床经验，在应用程序中的手术简报，高可靠性的围产期护理的属性，关键事件的培训和模拟的价值，以及从医院转移到熟练的护理设施的患者的护理标准化的沟通过程中的好处。此外，还介绍了在实现文化变革方面的有效技术、改善工作环境质量的证据、实践转移战略、关键成功因素以及展示此类工作益处的不断演变的方法等方面所吸取的经验教训。
Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language'' to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.