背景:公开披露(OD)是与受影响者就医疗保健引起的有害事件进行公开和及时的沟通。这是服务用户的权利,也是他们恢复的一个方面,以及服务安全改进的重要维度。最近,英国国家卫生服务机构在产妇保健中的OD已经成为一个紧迫的公共问题,政策制定者推动多种干预措施,以管理沟通失败的财务和声誉成本。只有有限的研究来了解OD是如何工作的及其在不同的背景下的影响。
方法:现实主义文献筛选,数据提取,以及涉及两个咨询利益相关者团体的逆向理论化。与家庭相关的数据,临床医生,和服务被映射来理论化上下文之间的关系,机制,和结果。从这些地图上,确定了成功OD的关键方面。
结果:经过真实的质量评估,综述中包括38份文件(22份学术文件,2培训指导,和14份政策报告)。从所包括的文件中确定了135个解释性帐户(n=41与家庭有关;n=37与工作人员有关;n=37与服务有关)。这些在理论上被认为是五个关键机制集:(a)对伤害的有意义的承认,(b)家庭参与审查和调查的机会,(c)家庭和工作人员了解发生的事情的可能性,(d)临床医生的专业技能和心理安全,(e)家庭和工作人员知道情况正在改善。确定了三个关键的背景因素:(a)事件的配置(如何以及何时确定和分类为严重程度或多或少);(b)国家或州的驱动因素,比如政策,法规,和计划,旨在促进OD;和(c)接收和协商这些驱动因素的组织背景。
结论:这是对OD是如何工作的理论的第一篇综述,为谁,在什么情况下,以及为什么。我们从次要数据中确定并检查了成功OD的五个关键机制以及影响这一点的三个环境因素。下一个研究阶段将使用访谈和人种学数据进行测试,深化,或推翻我们的五个假设的计划理论,以解释加强产科服务OD所需的条件。
BACKGROUND: Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts.
METHODS: Realist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified.
RESULTS: After realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated.
CONCLUSIONS: This is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.