No / Introduction Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur. Methods 297 patients from 11 hospital wards completed the PMOS questionnaire during their stay; 25 completed a second 1 week later. The Agency for Healthcare Research and Quality (AHRQ) safety culture survey was completed by 190 staff on 10 of these wards. Factor structure, internal reliability, test-retest reliability, discriminant validity and convergent validity were assessed. Results Factor analyses revealed 8 key domains of safety (eg, communication and team work, access to resources, staff roles and responsibilities) explaining 58% variance of the original questionnaire. Cronbach’s α (range 0.66–0.89) and test-retest reliability (r=0.75) were good. The PMOS positive index significantly correlated with staff reported ‘perceptions of patient safety’ (r=0.79) and ‘patient safety grade’ (r=−0.81) outcomes from the AHRQ (demonstrating convergent validity). A multivariate analysis of variance (MAMOVA) revealed that three PMOS factors and one retained single item discriminated significantly across the 11 wards. Discussion The PMOS is the first patient questionnaire used to assess factors contributing to safety in hospital settings from a patient perspective. It has demonstrated acceptable reliability and validity. Such information is useful to help hospitals/units proactively improve the safety of their care.

Despite an increase in research regarding the healthcare outcomes and experiences of diverse groups, some significant gaps in the literature remain. Among the most understudied and underserved groups are those with intersectional identities. Although researchers have made significant efforts to increase research regarding health care experiences of people of color, older adults, and rural populations, less is known about the health care experiences of older rural African Americans. Due to the lack of research focusing on the unique experiences of this intersectional group, qualitative research was an important first step towards broadening this research base. This study utilized a cultural safety perspective of older rural African Americans to provide insight into several factors that influence their healthcare experiences. Prior to this study, no qualitative research utilizing the cultural safety framework has been conducted to examine the unique challenges that older rural African Americans face within the United States healthcare system or how their experiences may impact later treatment-seeking behavior and treatment adherence. To address this gap in the literature, this study examined the lived experiences of a sample of 47 African American participants, aged 55 and older, living in rural Mississippi. Participants completed semi-structured interviews regarding their health care experiences and attitudes. Thematic analysis was used to identify common themes. Some of the most prevalent themes were related to the importance of good communication, the importance of positive experiences in creating trust, and patients advocating for their own health. Specific implications and future research directions are discussed.

Introduction: In recent decades, there has been considerable international attention directed towards minimising healthcare-associated harm and improving the safety of hospital care. More recently, this attention has broadened to include primary medical care. In 2002, the World Health Assembly recognised the issue of inadequate levels of patient safety as a major threat to global public health. In the following years, many countries have developed national strategies for the measurement, monitoring and prevention of patient safety incidents (PSIs) and their outcomes. Experience accumulated from secondary care has shown that the initial steps for understanding patient safety include the systematic identification of the most frequent and most harmful threats. However, the safety profile of primary care dentistry remains poorly investigated. As a result, current evidence cannot provide reliable estimates of the types of PSIs in primary care dentistry, the causes of these incidents, or the associated disease burden caused by such incidents. In medicine, improvements in patient safety were achieved at a national level by developing a shared conceptual understanding, the standardisation of terminology and through preventive initiatives such as the introduction of a national incident reporting and learning system. In the United Kingdom (UK), the England and Wales’ National Reporting Learning System (NRLS) has been an important source of insight, from the perspectives of the reporter, into understanding why PSIs occur. This initiative has led to the implementation of patient safety oriented policies to monitor and reduce cases of healthcare-associated harm. Examples of such policy initiatives include national guidelines and national safety recommendations to encourage the reporting of serious reportable events called ‘never events’ (NEs). These are defined as serious, preventable PSIs that should not occur if the available preventive measures are implemented. At a national level, serious incidents and NEs must be reported to the NRLS and/or other reporting systems. However, little is known about NEs in dentistry as wrong-tooth extractions are the only currently defined NE that has a clear application in dentistry. Although surgical NEs, such as wrong-site surgery and wrong implants may be related to dental procedures, these overlap with procedures conducted in secondary care. As a result, there is no agreed list of NEs for primary care dentistry. The overall aim of my PhD was to explore patient safety, its concepts, including error and harm, and how these can help to create an understanding of the types of PSIs that occur in primary care dentistry, their contributory factors and their consequences. In addition, I also aimed to identify NEs with the greatest need and opportunity for future intervention strategies, in order to improve patient safety in primary care dentistry. Methodology and methods: My PhD was conducted in three phases. For the first phase, I conducted a systematic scoping review of the empirical evidence published over a 20-year period (1994-2014). To achieve this, I searched MEDLINE and EMBASE for articles reporting incidents that could have or did result in unnecessary harm from primary dental care. I also extracted and synthesised data on the types and frequencies of PSIs (including NEs) and adverse outcomes. Then, for the second phase, I undertook an exploratory sequential mixed-methods evaluation, which involved the qualitative exploration and analysis of a weighted-by-year randomised sample (n=2,000) of the most severe incident reports from primary care dentistry submitted to the England and Wales’ NRLS. This approach generated three coding frameworks, aligned to the International Classification for Patient Safety developed by the World Health Organization, for i) the classification of incidents, ii) contributor y factors and iii) incident outcomes. These coding frameworks informed the quantitative analysis, during which myself together with a trained second coder, applied codes to deconstruct the narrative of these patient safety incident reports whilst retaining the meaning of the report. To assess inter-rater reliability, Cohen’s Kappa statistic was calculated for the primary incident type which was defined as “the incident that resulted in the outcome experienced by the patient.” Finally, for the third phase, I undertook an electronic Delphi exercise to achieve international agreement on NEs for primary care dentistry. The results obtained from Phases 1 and 2 were used to identify candidate NEs. I then invited an international panel of 41 experts to complete two rounds of questionnaires; 32 (78%) agreed to participate and completed the first round, and 29 (91%) completed the second round. I provided anonymised controlled feedback between rounds and used a cut-off of 80% agreement to define consensus. The results from the first stage built the evidence base for the second and third phases. Likewise, the results from the second phase further informed the third and final stage of my PhD. Results: I undertook a systematic scoping review which demonstrated: a) there were considerable differences in definitions for terms used to describe patient safety, b) that a range of populations had been studied, and c) that major differences in sampling strategies exist between studies. The main five PSIs I identified were errors in i) diagnosis/examination, ii) treatment planning, iii) communication, iv) procedural errors and v) the accidental ingestion or inhalation of foreign objects. However, little attention has been paid to wider organisational factors such as problems within the physical environment, scheduling (e.g. errors in managing appointments) and patient access, management and lines of responsibility. Also there is very little evidence of interest in researching into the influence of policies for either quality or patient safety assurance. The retrieved evidence was used to build a conceptual literature-derived model of patient safety risks in primary care dentistry. This model helped to bring structure to the analysis of the 1,456 patient incident reports that were eligible for analysis out of a total of 2,000. These reports described incidents across the preoperative (40.3%; n=587), intra-operative (56.1%; n=817) and post-operative (3.6%; n=52) clinical stages of care delivery. Further analysis showed the more frequently reported incidents were related to a) delays in treatment (333/1,456; 22.9%), b) procedural errors (220/11,456; 15.1%), c) medication-related adverse incidents (160/1,456; 11.0%), d) equipment failure (90/1,456; 6.2%) and e) errors in obtaining or processing x-rays (87/1,1456; 6.0%). Only 5.3% (77/1,456) of the incidents resulted in harmful outcomes. Of the 77 incidents that resulted in a harmful outcomes (n=77; 5.3%), around half were due to wrong tooth extractions (37/77; 48.1%) and resulted in unnecessary procedures. Three out of the 1,456 incidents (0.2%) resulted in death. Data from the scoping review and the mixed-method analysis informed a list of 42 candidate NEs. I further sought and achieved international consensus for 23 of these NEs. These were related to routine assessment, and pre-operative, intra-operative and post-operative stages of dental procedures. Conclusions: The findings from my PhD have revealed that patient safety research in dentistry is mostly descriptive and poorly organised with various approaches to defining and measuring PSIs and their outcomes. This poor organisation of patient safety research also includes differing study designs and patient populations studied. The evidence-based conceptual framework from the systematic scoping review, and coding frameworks from analysis of PSI reports selected from a national database, can bring structure to future work by providing a robust approach to classifying PSIs, their contributory factors and outcomes. / My research findings also show that PSI reports are an important source of information that can generate important insights about patient safety in primary care dentistry. The mixed-method analysis of PSI reports showed that most incidents in primary dental care do not result in harm. PSIs that resulted in harmful outcomes more frequently occurred intra-operatively. My findings also reveal that unsafe care in dentistry is not limited to human error, but can also be ascribed to the presence of other administrative or organisational flaws that contribute to the reported incidents. Future initiatives to improve and research clinical practice should focus on improving administrative processes to reduce delays in treatment. Also, the reduction of procedural errors through the standardisation of x-rays, medication prescription and other clinical procedures is needed. Lastly, I have constructed the first comprehensive international list of NEs for primary care dentistry. I believe my findings, including the list of NEs, can provide an evidence-base which will encourage researchers to further expand the patient safety research and development agenda in dentistry, as well as encouraging decision-makers and professional bodies to translate my findings into quality improvement strategies.

Healthcare risk management consists of continuous consideration of potential adverse situations and their prevention. In this sense, healthcare facilities consider any source of uncertainty to be a risk which must be eliminated or, at least, reduced. International studies show that up to 70% of adverse events could be prevented. Reasons for observing various types of adverse events may differ in individual healthcare facilities. However, most adverse events are observed in an effort to prevent their consequences upon patients' health.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T14:20:42Z No. of bitstreams: 2 Dissertacao_SimoneFranciscattoPanno.pdf: 24728642 bytes, checksum: 70b8361698b1e4342af3bd188424423e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-08-22T14:20:42Z (GMT). No. of bitstreams: 2 Dissertacao_SimoneFranciscattoPanno.pdf: 24728642 bytes, checksum: 70b8361698b1e4342af3bd188424423e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-11-30 / The correct identification of the patient is fundamental in the provision of safe care, being the first international safety goal of the World Health Organization. Protocols for patient identification in health services standardize actions and reduce the occurrence of errors. The general objective of this study was to evaluate the adherence of the professionals to the institutional protocol of identification of the patient, in the pediatric units of a teaching hospital. As specific objectives were considered: verify if the health care professionals identify the patients with bracelets; identification of the patient prior to care / procedures / transfers / discharge and educating / advising patients / caregivers on the correct identification, according to the protocol; verify the presence and general compliance of identification wristbands; and, produce a video emphasizing the importance of identification actions. A cross-sectional study was carried out, with a descriptive design and a quantitative approach. The population was composed by the health / support professionals, who worked in the care of patients of the Pediatric Emergency Room, the Pediatric Intensive Care Unit and the Pediatric Clinical and Surgical Unit of a teaching hospital in Rio Grande do Sul. The sample consisted of 385 opportunities of actions. At each opportunity, we sought: to verify if the patients were identified with bracelets - action 1; to observe if the professionals confer the identification of the patients - action 2; and, if the patients / companions were educated about the correct identification - action 3. Also, in the opportunities in which the bracelet was present, the conformity of the bracelet with the protocol was verified. Data collection took place from April to June 2017, through the completion of a research instrument. Data was entered into Excel 2007 spreadsheets and analyzed by descriptive statistics. The adhesion of professionals to action 1 was 74.28%, action 2 had no adhesion, and action 3 had adhesion of 2.08%. The bracelet was present at 82.85% of the opportunities and overall compliance was 12.22%. Regarding the location / fixation of the bracelet, compliance was 89.56%; in the presence of the three correct identifiers, 25.07% and, in the specifications, 69.29%. The findings contributed to establish the situational diagnosis of the professionals' adherence to the institutional protocol. In addition, it will enable the implementation of measures for compliance with the proposed actions and strengthening of the safety culture. The resulting product was a video aimed at informing and sensitizing health professionals / support, patients and caregivers as to the importance of the first goal. / A identificação correta do paciente é fundamental na prestação do cuidado seguro, sendo a primeira meta internacional de segurança da Organização Mundial da Saúde. Os protocolos para identificação do paciente nos serviços de saúde padronizam as ações e reduzem a ocorrência de erros. O objetivo geral deste estudo foi avaliar a adesão dos profissionais ao protocolo institucional de identificação do paciente, nas unidades pediátricas de um hospital de ensino. Como objetivos específicos foram considerados: verificar se os profissionais de saúde/apoio identificam os pacientes com pulseiras; se conferem a identificação do mesmo antes dos cuidados/procedimentos/transferências/alta e se educam/orientam os pacientes/ acompanhantes sobre a correta identificação, conforme o protocolo; verificar a presença e a conformidade geral das pulseiras de identificação; e, produzir um vídeo enfatizando a importância das ações de identificação. Realizou-se um estudo transversal, com delineamento descritivo e abordagem quantitativa. A população foi composta pelos profissionais de saúde/apoio, atuantes na assistência aos pacientes do Pronto Socorro Pediátrico, Unidade de Tratamento Intensivo Pediátrico e Unidade Pediátrica Clínica e Cirúrgica de um hospital de ensino do Rio Grande do Sul. A amostra foi constituída por 385 oportunidades de observação das ações. Em cada oportunidade buscou-se: verificar se os pacientes estavam identificados com pulseiras – ação 1; observar se os profissionais conferiam a identificação dos pacientes – ação 2; e, se realizavam a educação dos pacientes/acompanhantes sobre a identificação correta – ação 3. Também, nas oportunidades em que a pulseira estava presente foi verificada a conformidade da mesma com o protocolo. A coleta dos dados ocorreu de abril a junho de 2017, mediante o preenchimento de um instrumento de pesquisa. Os dados foram digitados em planilhas do Excel 2007 e analisados por estatística descritiva. A adesão dos profissionais à ação 1 foi de 74,28%, a ação 2 não teve adesão, já a ação 3 teve adesão de 2,08%. A pulseira estava presente em 82,85% das oportunidades e a conformidade geral foi de 12,22%. Em relação à localização/fixação da pulseira, a conformidade foi de 89,56%; na presença dos três identificadores corretos, 25,07% e, nas especificações, 69,29%. Os achados contribuíram para estabelecer o diagnóstico situacional da adesão dos profissionais ao protocolo institucional. Além disso, possibilitará a implementação de medidas em prol do cumprimento das ações propostas e fortalecimento da cultura de segurança. O produto resultante foi um vídeo com a finalidade de informar e sensibilizar os profissionais de saúde/apoio, paciente e acompanhantes, quanto à importância da primeira meta.

This thesis aims at investigating the importance of effective implementation of health safety and hygiene legislations and practices in Health Care delivery systems. A new System Based Approach for Strategic Implementation of Occupational Health & Safety Practices is proposed in this thesis. The underlying principle of the approach is based on involvement and inputs from staff and management rather than by pre-specified requirements and objectives. Furthermore, the development process is a closed loop process that provides a mechanism for continuously evaluating system performance and monitoring activities that have considerable impact on health and safety practices. A case study was conducted in the medical laboratories of five major hospitals in the Emirate of Abu Dhabi. Data were collected through questionnaires, staff interviews, and reviewing laboratory safety reports compiled over a three years period. The main conclusions from this study are: 1. The proposed approach has proven to be useful in analyzing existing health and safety systems. The methodology and tools proved to be instrumental in defining inefficiencies and determining the status of the Health & Safety policies & practices in the selected medical laboratories. 2. Effective implementation of the proposed approach has shown improvements in productivity, operational cost, service quality, staff and management satisfaction. 3. The case study has demonstrated that a developing country such the UAE, with no previously existing Health & Safety legislation and little risk prevention culture, can rapidly and effectively introduce effective industry specific H&S by adopting an integrated systems based approach. 4. UAE has highly advanced and economically developing base, there is a general willingness at senior level within the UAE to achieve high levels of competence and standards in all industrial sectors. 5. CAP is a system based management tool which has been implemented globally, but only limited in the gulf region; CAP has been implemented by the author and colleges within Zayed Military Hospital between 2003-2007.

Made available in DSpace on 2014-12-17T14:47:04Z (GMT). No. of bitstreams: 1 KisnaYAA_DISSERT.pdf: 3597363 bytes, checksum: e93daa258fbca2cb9d05dce2355b4c24 (MD5) Previous issue date: 2014-02-07 / The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units / Os relatos sobre eventos adversos datam desde 1990, contemporizando-se at? os dias atuais. Conceitualmente, os eventos adversos s?o inj?rias n?o intencionais e sem rela??o com a doen?a de base, provocando les?es mensur?veis em pacientes, prolongamento do per?odo de interna??o ou ?bito. S?o tem?ticas que demandam discuss?es, no tocante ? seguran?a do paciente, melhorias na qualidade do servi?o e na preven??o de erros no atendimento ao paciente. Na Unidade de Terapia Intensiva, essa preocupa??o ? ampliada, pois s?o setores de cuidados intensivos aos indiv?duos com altera??es hemodin?micas e iminente risco de morte. Assim, ? fundamental a realiza??o de processos avaliativos para investigar os aspectos de qualidade do cuidado de enfermagem e da seguran?a do paciente nesses espa?os. Diante disso, objetivou-se propor o Protocolo de avalia??o do cuidado de enfermagem e da seguran?a do paciente nas Unidades de Terapia Intensiva . Para alcan??-lo, fez-se necess?rio: 1) analisar a evolu??o do conceito seguran?a do paciente empregado nas produ??es cient?ficas, sob a vis?o evolucion?ria de Rodgers; 2) identificar os itens necess?rios para compor o protocolo de avalia??o do cuidado de enfermagem e da seguran?a do paciente na Unidade de Terapia Intensiva, a partir das evid?ncias da literatura; 3) construir um instrumento para valida??o de conte?do do protocolo de avalia??o do cuidado de enfermagem e da seguran?a do paciente na Unidade de Terapia Intensiva; e 4) descrever e avaliar a adequa??o do conte?do para um protocolo de avalia??o do cuidado de enfermagem e da seguran?a do paciente na Unidade de Terapia Intensiva. Trata-se de um estudo metodol?gico, para valida??o de conte?do do protocolo supracitado. Para atender os tr?s primeiros objetivos espec?ficos, utilizou-se a revis?o integrativa da literatura no Banco de Teses da Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior e no portal do Centro Colaborador para a Qualidade do Cuidado e a Seguran?a do Paciente. O quarto objetivo espec?fico foi concretizado pela participa??o de ju?zes, localizados atrav?s dos curr?culos Lattes, no processo de valida??o de conte?do desenvolvido em duas etapas: Delphi 1 e Delphi 2. Como instrumento, utilizou-se o formul?rio eletr?nico do google docs. As respostas provenientes dos instrumentos de avalia??o s?o apresentadas, mediante consenso de Delphi e ?ndice de Validade de Conte?do (IVC) de todo o protocolo, em tabelas. Os resultados foram sintetizados nos artigos intitulados A an?lise do conceito seguran?a do paciente: a vis?o Evolucion?ria de Rodgers , Evid?ncias cient?ficas acerca da seguran?a do paciente na Unidade de Terapia Intensiva ; Dispositivo tecnol?gico para processo de valida??o de conte?do: relato de experi?ncia ; e Protocolo de avalia??o do cuidado de enfermagem e da seguran?a do paciente nas Unidades de Terapia Intensiva . O estudo foi aprovado pelo Parecer Consubstanciado do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, n? 461.246, sob CAAE n? 19586813.2.0000.5537. Conclui-se que o protocolo, v?lido em seu conte?do, constitui uma importante ferramenta de avalia??o da qualidade do cuidado de enfermagem e da seguran?a do paciente em Unidades de Terapia Intensiva

No description available.

Cotutelle France-Québec / La médiation présente un fort potentiel dans la régulation des rapports entre patients et professionnels de santé et de nombreux bénéfices dans le domaine de la santé lequel se prête aisément à la mise en œuvre des modes amiables de règlement des différends. L’utilisation marginale de la médiation en santé invite alors à considérer les facteurs juridiques susceptibles de l’expliquer. Ce travail visait donc à déterminer, le cadre juridique optimal susceptible de favoriser le recours – ou promouvoir le développement – de la médiation extrajudiciaire dans les différends nés de la relation de soin. L’hypothèse étant que la faible efficacité incitative des législations applicables à la médiation en santé représente un facteur dissuasif à son utilisation, cette efficacité étant tributaire du degré d’adaptation de ces législations à la nature spécifique des différends en santé. Le travail s’appuie sur une analyse comparative franco-québécoise, le Québec et la France étant tous deux au diapason s’agissant d’encourager le recours à la médiation. Un cadre d’analyse pour juger de l’adéquation des législations québécoise et française applicables à la médiation en santé aux différends nés de la relation de soin a d’abord été dégagé de l’étude de la singularité de ces différends. La comparaison des corpus juridiques québécois et français a ensuite montré des différences dans l’appréhension de la médiation mais également des similarités notamment s’agissant des difficultés concernant son implantation dans le champ de la santé. Les démarches faites pour les surmonter à la fois se rejoignent et diffèrent puisqu’elles dépendent de deux paramètres : assurer un environnement favorable au recours et structurer les conditions de la fonction de médiation. Ainsi, l’environnement juridique, à la fois conceptuel et axé sur l’information, l’accompagnement et l’accessibilité des justiciables, et la formation des acteurs de la médiation en santé sont donc cruciaux pour son avenir dans le champ de la santé. En prenant appui sur les forces des cadres juridiques québécois et français, le modèle de référence de la médiation en santé proposé s’inscrit, d’abord, dans un cadre global plus large visant à insuffler une véritable culture de médiation. Ensuite, il repose sur une approche pragmatique et donc sur une conception de la médiation en santé « hybride » qui se détache de la définition communément adoptée par la doctrine. Ce cadre de référence propose de renouveler le champ d’application de la médiation par une approche centrée sur le concept de qualité et de sécurité de soins. Le potentiel de la médiation dans l’amélioration de la qualité et de la sécurité de soins est sûrement l’élément clé qui fonde la spécificité de cette médiation et sur lequel il conviendrait de davantage insister en tant que finalité explicite de cette médiation. La médiation en santé pourrait ainsi bénéficier d’un ancrage pérenne et s’insérer plus aisément dans le répertoire des pratiques institutionnelles. Par ailleurs, en tant qu’instrument au service de l’amélioration de la qualité de soins et de prévention des erreurs médicales, la médiation n’est plus seulement un instrument « curatif » de gestion de crise. Elle offre plutôt un panel d’options permettant de répondre à l’extrême diversité des besoins des parties au différend né de la relation de soin. Au travers de cette étude, nous montrons in fine l’existence d’un besoin accru de médiation au sein des deux systèmes de santé et de quelle manière le droit peut constituer un moteur essentiel pour promouvoir un certain modèle de médiation en santé et favoriser ou non son recours. / Mediation has great potential in the regulation of relations between patients and health professionals and many benefits in the health field, which lends itself easily to the implementation of alternative dispute resolution methods. The marginal use of mediation in the health field invites us to consider the legal factors that could explain it. The aim of this work was therefore to determine the optimal legal framework likely to encourage the use - or promote the development - of extrajudicial mediation in disputes arising from the care relationship. The hypothesis being that the low incentive efficiency of the legislations applicable to mediation in health represents a dissuasive factor to its use, this effectiveness being dependent on the degree of adaptation of these legislations to the specific nature of the disputes in health. The work is based on a comparative Franco-Quebec analysis, with both Quebec and France being in tune in terms of encouraging the use of mediation. An analytical framework for judging the adequacy of the Quebec and French legislation applicable to mediation in the health sector to disputes arising from the health care relationship was first identified by studying the singularity of these disputes. The comparison of the Quebec and French legal corpora then showed differences in the apprehension of mediation but also similarities, in particular with regard to the difficulties concerning its implementation in the health field. The steps taken to overcome them are both similar and different since they depend on two parameters: ensuring an environment favourable to recourse and structuring the conditions of the mediation function. Thus, the legal environment, both conceptual and focused on information, support and accessibility of litigants, and the training of the actors of mediation in health are crucial for its future in the health field. By building on the strengths of the Quebec and French legal frameworks, the proposed reference model for mediation in health is, first, part of a broader global framework aimed at instilling a true mediation culture. Secondly, it is based on a pragmatic approach and therefore on a conception of « hybrid » mediation in health care that is different from the definition commonly adopted by the doctrine. This reference framework proposes to renew the field of application of mediation by an approach centred on the concept of quality and safety of care. The potential of mediation in the improvement of the quality and safety of care is surely the key element that founds the specificity of this mediation and on which it would be advisable to insist more as an explicit purpose of this mediation. Mediation in health care could thus benefit from a perennial anchoring and be more easily inserted in the repertoire of institutional practices. Moreover, as an instrument for improving the quality of care and preventing medical errors, mediation is no longer just a "curative" instrument for crisis management. Rather, it offers a range of options to meet the extremely diverse needs of the parties to the dispute arising from the care relationship. Through this study, we show in fine the existence of an increased need for mediation within the two health systems and how the law can constitute an essential driving force to promote a certain model of mediation in health and to promote or not its recourse.