香港大学深圳医院患者安全文化剖析

摘要

Objective:To evaluate the patient safety culture in The University of Hong Kong,Shenzhen Hospital (HKUSZH) after introducing patient safety culture and strategies from Hong Kong.Methods:Quantitative and qualitative researches were conducted based on Hospital Survey on Patient Safety Culture (HSOPSC).Results:Those who were found to be more positive towards the hospital's patient safety culture were male,doctor,with longer working years and higher educational level;while those who were less positive were female,nurse,with shorter working years and lower educational level.Semi-structure interviews were conducted with 12 staff selected from the above two groups.Results from the quantitative and qualitative researches reveal that the hospital's management level regards patient safety as a top priority.Staff rated high to the hospital on the overall patient safety culture level.Staff can actively report and share incidents,but they don't have full trust in the non-punitive culture in the hospital.There is an unclear management organizational structure for patient safety management,and the definition of non-punitive culture is still ambiguous.These constitute barriers to promote an open and just culture for patient safety in the hospital.The teamwork for patient safety was better within unit than across units.The hospital's staffing problem was found to go against patient safety.Conclusion:Though HKUSZH has some achievements on patient safety management,its patient safety culture still needs to be enhanced.For better patient safety culture,the hospital needs to seek improvements on its structure.Teamwork problem across units and staffing problem need to be addressed.The effectiveness of patient safety management should be enhanced so that the patient safety culture can be embedded in the minds of staff from all levels.A comprehensive organizational structure for patient safety is suggested for an open and justice culture in the hospital.%目的:研究香港大学深圳医院在引进香港患者安全文化理念及做法后其患者安全文化现状.方法:使用汉化的医院患者安全文化调查问卷(hospital survey on patient safety culture,HSOPSC)进行定量调查,并结合半结构访谈法对部分人员进行半结构访谈.结果:定量调查结果显示,评分较低的群体特征为男性、工作年限较长、学历较高、医生,评分较高的为女性、工作年限较短、学历较低、护士,在这两个群体中访谈了12名员工.调查和访谈结果显示,医院管理层重视医疗安全,且患者安全文化级别高;员工积极上报和分享不良事件,但对无惩罚文化有所顾虑;患者安全管理架构及无惩罚定义的不清晰,不利于促进患者安全的公开公平文化建设;部门内部合作较好,但跨部门团队合作较差;其人力资源配置问题不利于患者安全.结论:香港大学深圳医院在患者安全管理策略方面虽取得成效,但患者安全文化建设仍有待加强.医院需要在患者安全顶层设计方面进一步探索,优化跨部门团队合作和人力资源配置,加强患者安全的实践效果,让患者安全文化理念深植于员工心中,完善患者安全管理体系以促进患者安全的公开公平文化建设.