PDF(Pubmed)
Abstract：
BACKGROUND: In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified?
METHODS: We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects.
RESULTS: We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units.
CONCLUSIONS: This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.
METHODS: We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects.
RESULTS: We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units.
CONCLUSIONS: This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.
摘要：
背景：在安全系统时代，建立安全文化的医院干预措施为员工提供组织学习方法。他们对医院工作人员的好处是未知的。我们检查了文献，以获得员工结果的证据。研究问题是：（1）旨在增强干预措施的研究中安全文化是如何定义的？（2）改善安全文化的干预措施对医院工作人员有什么影响？（3）哪些干预功能解释了这些影响？（4）确定了哪些工作人员的结果和经验？
方法：我们使用系统评价和分析的首选报告项目对已发表的文献进行了混合方法系统评价。搜索是在MEDLINE进行的,EMBASE,CINAHL,健康商业精英和Scopus。我们采用了一种融合的方法来进行综合和集成。已确定的干预措施和工作人员结果按主题进行分类，并结合有关措施和效果的可用数据。
结果：我们确定了42篇文章。在领导力和团队合作主题下，安全文化成果最为突出。员工的具体福利包括增加压力识别和工作满意度，减少情绪疲惫，倦怠和营业额，改善工作条件。记录了更长时间尺度的干预措施的效果，强有力的制度支持和位于特定单位内的全面的理论知情设计。
结论：本综述为改善安全文化的干预措施如何使医院工作人员受益以及如何设计和实施提供了国际证据。对员工成果的关注包括作为安全文化一部分的员工观念和行为以及安全文化带来的员工经验。少量文章产生的结果在质量和效果上各不相同，审查只针对医院工作人员。使用安全文化的概念作为镜头来了解复杂的医疗保健系统中的员工经验是值得的。
方法：我们使用系统评价和分析的首选报告项目对已发表的文献进行了混合方法系统评价。搜索是在MEDLINE进行的,EMBASE,CINAHL,健康商业精英和Scopus。我们采用了一种融合的方法来进行综合和集成。已确定的干预措施和工作人员结果按主题进行分类，并结合有关措施和效果的可用数据。
结果：我们确定了42篇文章。在领导力和团队合作主题下，安全文化成果最为突出。员工的具体福利包括增加压力识别和工作满意度，减少情绪疲惫，倦怠和营业额，改善工作条件。记录了更长时间尺度的干预措施的效果，强有力的制度支持和位于特定单位内的全面的理论知情设计。
结论：本综述为改善安全文化的干预措施如何使医院工作人员受益以及如何设计和实施提供了国际证据。对员工成果的关注包括作为安全文化一部分的员工观念和行为以及安全文化带来的员工经验。少量文章产生的结果在质量和效果上各不相同，审查只针对医院工作人员。使用安全文化的概念作为镜头来了解复杂的医疗保健系统中的员工经验是值得的。
