目的 破解军队医疗机构平时医疗安全管理中概念零散、导向被动、协同低效的现实困境,提出并论证军队平时医疗不良事件统摄性概念,构建覆盖隐患至事故全谱系、融合技术与人为因素的综合治理框架,为提升军队平时医疗安全治理能力提供理论支撑。方法 系统辨析医疗事故、医疗纠纷等传统概念的局限性,论证新概念的必要性与科学性。以瑞士奶酪模型、海恩法则为理论基石,阐释新概念系统性、过程性、可预防性核心内涵,构建分类―分级的二维管理模型。结果 明确界定军队平时医疗不良事件概念,揭示其为医疗系统多层防御失效与风险量变质变共同作用的结果;构建技术类、管理类、行为类三维分类与科室/岗位级、机构/军内级、军地/战略级三级响应的结构化治理模型,为风险预警、根本原因分析(RCA)、分级处置提供操作路径。结论 该概念突破传统碎片化管理局限,推动治理重心从事后处置向事前预防、系统改进转型,助力军队医疗机构构建主动防御型安全文化,实现从个人问责向系统学习的范式转变,为提升军队平时医疗服务体系韧性与安全治理能力提供理论依据。

Objective To address the current predicament of fragmented concepts, passive orientation and inefficient coordination in peacetime medical safety management in military medical institutions, to propose and demonstrate an overarching concept of military medical adverse events, and to build a comprehensive governance framework covering the whole spectrum from hidden dangers to accidents and integrating technical and human factors, so as to provide a unified theoretical support for the improvement of the ability of safety governance in military peacetime medical care. Methods The limitation of traditional concepts such as medical accidents and medical disputes was systematically analyzed, while the necessity and scientificity of the new concept were demonstrated. Based on the Swiss cheese model and Heinrich's law, the core connotation of the new concept, including systematicity, processuality and preventability, was explained, and a two-dimensional classification grading management model was constructed. Results The concept of military medical adverse events was clearly defined, revealing that it was the result of multiple layers of defense failure and quantitative and qualitative changes of risks in the medical system. A structured governance model was constructed, including three-dimensional classification (technical, managerial, behavioral) and three level response (department/post level, institution/military internal level, military civil/strategic level), which provided an operational path for risk early warning, root cause analysis (RCA) and graded disposal. Conclusions This concept breaks through the limitations of traditional fragmented management, and shifts the governance focus from post-event handling to pre-event prevention and system improvement, helping military medical institutions build an active defense-oriented safety culture and facilitating a paradigm shift from individual accountability to system learning, which provides theoretical basis for the improvement of the resilience and safety governance capacities of military peacetime medical service system.