Improving Safety Culture and Outcomes in Healthcare

描述（由申请人提供）：由于缺乏与成功实施患者安全倡议和减少可避免伤害的综合患者安全计划的有效性相关的因素的证据，有效促进患者安全计划——从而提高患者安全——仍然受到阻碍。该项目旨在通过开发有关市场与组织特征、组织安全文化和患者安全之间关系的全国性证据，改善医疗保健中的患者安全、安全文化和结果。在斯坦福大学正在进行的研究成果和方法技术的基础上进行扩展，我们的具体目标是：(1)进一步验证医疗保健组织中的患者安全文化调查工具，(2)了解医院特征和实践、安全文化和患者结果之间的关系，以及(3)通过准备高管探索其机构一线工作的现实来改善安全文化。斯坦福大学卫生政策中心和初级保健和结果研究中心（CHP/PCOR）、VA帕洛阿尔托医疗保健系统患者安全调查中心、医疗保健组织认证联合委员会、海军研究生院、参与医院等（“患者安全联盟”）的合作将通过在全国范围内不同的医院样本中测量安全文化来实现这些目标；评估个人、医院特征与安全文化之间的关系；确定安全文化与医疗融资和组织方面之间的关系，例如管理式医疗活动和医院竞争；医院与非医疗、高危行业高可靠性组织的安全文化比较确定安全文化、患者安全的其他潜在决定因素与患者成本和结果之间的关系；随着时间的推移，跟踪安全文化和这些关系的变化；实施和评估旨在改善安全文化的实际干预措施。

DESCRIPTION (Provided by applicant): Effective promotion of patient safety programs-and therefore patient safety improvement-remains hampered by the paucity of evidence on the factors associated with successful implementation of patient safety initiatives and on the effectiveness of comprehensive patient safety programs for reducing avoidable injuries. This project aims to improve patient safety, safety culture, and outcomes in healthcare by developing national evidence on the relationship between market and organizational characteristics, organizational safety culture, and patient safety. Expanding upon findings and methodological techniques proven through ongoing work at Stanford, we specifically aim (1) to validate further the Patient Safety Cultures in Healthcare Organizations survey instrument, (2) to understand the relationship between hospital characteristics and practices, safety culture, and patient outcomes, and (3) to improve safety culture by preparing executives to explore the realities of front-line work in their institutions. A collaboration of Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research (CHP/PCOR), the Patient Safety Center of Inquiry at VA Palo Alto Health Care System, the Joint Commission for Accreditation of Health Care Organizations, the Naval Postgraduate School, participating hospitals, and others (the "Patient Safety Consortium") will achieve these aims by measuring safety culture in a diverse, nationwide sample of hospitals; assessing the relationship between individual and hospital characteristics and safety culture; determining the relationship between safety culture and aspects of healthcare financing and organization, such as managed care activity and hospital competition; comparing safety culture in hospitals to high-reliability organizations in non-medical, high-hazard industries; determining the relationship between safety culture, other potential determinants of patient safety, and patient costs and outcomes; tracking changes in safety culture and these relationships over time; and implementing and evaluating a practical intervention designed to improve safety culture.