Background

Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel’s resilience assessment grid (RAG) into a custom-made RAG (ED-RAG) to support resilience management in EDs.

Methods

The study approach had three parts: 1) translation of Hollnagel’s RAG into Chinese version, followed by generation of a tailored set of ED-RAG questions adapted to EDs; 2) testing and revising the tailored sets until to achieve satisfactory validity for application; 3) design of a new rating scale and scoring method. The test criteria of the ED-RAG questionnaire adopted the modified three-level scoring criteria proposed by Bloom and Fischer. The study setting of the field test is a private regional hospital.

Results

The fifth version of ED-RAG was acceptable after a field test. It has three sets of open structured questions for the potentials to respond, monitor, and anticipate, and a set of structured questions for the potential to learn. It contained 38 questions corresponding to 32 foci. A new 4-level rating scale along with a novel scaling method can improve the scores conversion validity and communication between team members and across investigations. This final version is set to complete an interview for around 2 hours.

Conclusions

The ED-RAG represents a snapshot of EDs’resilience under specific conditions. It might be performed multiple times by a single hospital to monitor the directions and contents of improvement that can supplement conventional safety management toward resilience. Some considerations are required to be successful when hospitals use it. Future studies to overcome the potential methodological weaknesses of the ED-RAG are needed.

中文翻译：

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复原力潜力的测量 - 为急诊部门开发复原力评估网格。

背景

过去十年来，在许多领域，弹性工程已被提倡作为安全管理的替代方案。然而，促进衡量和帮助分析急诊科 (ED) 恢复潜力的指标仍然是一项重大挑战。该研究旨在将 Hollnagel 的复原力评估网格 (RAG) 重新设计为定制的 RAG (ED-RAG)，以支持 ED 的复原力管理。

方法

研究方法分为三个部分：1）将Hollnagel的RAG翻译成中文版本，然后生成一套适合ED的定制ED-RAG问题；2）测试和修改定制的集合，直到达到满意的应用有效性；3）设计新的评分量表和评分方法。ED-RAG问卷的测试标准采用了Bloom和Fischer提出的修改后的三级评分标准。现场测试的研究背景是一家私立地区医院。

结果

ED-RAG 的第五版经过现场测试后是可以接受的。它包含三组针对响应、监控和预测潜力的开放式结构化问题，以及一组针对学习潜力的结构化问题。它包含 38 个问题，对应 32 个焦点。新的 4 级评分量表以及新颖的量表方法可以提高分数转换的有效性以及团队成员之间和跨调查的沟通。最终版本预计将完成约 2 小时的采访。

结论

ED-RAG 代表了 ED 在特定条件下的恢复能力。它可以由一家医院多次执行，以监测改进的方向和内容，以补充传统的安全管理以实现弹性。医院使用它时需要考虑一些因素才能取得成功。需要进一步的研究来克服 ED-RAG 潜在的方法学弱点。