Resilient health care: turning patient safety on its head
Resilient health care: turning patient safety on its head
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DOI：
10.1093/intqhc/mzv063
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Hollnagel, Erik
中科院分区：
文献类型：
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作者：
Braithwaite, Jeffrey;Wears, Robert L.;Hollnagel, Erik
目前的患者安全方法，标记为Safety-I，是基于“发现和修复”模型。它在事件发生后识别出出错的事情，并旨在消除它们，以确保错误的数量尽可能低。医疗保健比这种线性模型所显示的要复杂得多。我们需要把重点转移到我们称之为安全-II的东西上：一种协调一致的努力，使事情更经常地正确进行。关键是要认识到，医疗保健在很大程度上是有弹性的，日常表现成功的次数要比失败的次数多得多。临床医生不断调整他们所做的，以适应条件。促进工作的灵活性，并积极努力提高临床医生的能力，更有效地提供更多的护理，是这种新模式的关键。主动安全管理的核心是关注日常绩效通常如何成功，而不是为什么偶尔会失败，并积极努力改善前者，而不是简单地防止后者。
The current approach to patient safety, labelled Safety-I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety-II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter.