Integrating: A managerial practice that enables implementation in fragmented health care environments.
Integrating: A managerial practice that enables implementation in fragmented health care environments.
复制标题
整合：一种能够在分散的医疗保健环境中实施的管理实践。
DOI：
10.1097/hmr.0000000000000114
复制
发表时间：
2017
影响因子：
2.5
通讯作者：
Singer,Sara
中科院分区：
文献类型：
--
作者：
Kerrissey,Michaela;Satterstrom,Patricia;Leydon,Nicholas;Schiff,Gordon;Singer,Sara
背景：一些组织如何改善，而另一些组织则停滞不前，这是医疗保健研究中的一个关键问题。研究确定组织如何能够实施改进，尽管障碍是必要的，特别是在初级care.Purposes：这种归纳定性研究探讨初级保健诊所实施改进工作，以确定机制，使实施尽管共同的障碍，如缺乏时间和碎片在利益相关者groups.Methodology：使用嵌入式多个案例研究设计，我们利用纵向数据集的现场记录，会议纪要，并从16个初级保健诊所实施改进超过15个月的采访。我们将诊所分为实施较多的诊所和实施较少的诊所，比较异同。我们确定促进实施的人际机制，开发一个概念模型，我们的主要研究结果，并测试与性能的关系，使用病人进行调查前/后implementation.Findings：九个诊所实施更成功的研究期间，而七个实施less. Successfully实施诊所展示了整合的管理实践，我们定义为利益相关者群体之间的努力，在追求一个共同的和相互发展的目标实现统一。我们的理论，整合是至关重要的，因为在医疗保健环境中观察到的碎片化的改进实施，我们扩展理论的诊所经理在实施中的作用。我们确定了四个整合机制，诊所管理人员制定：参与团体，沟通桥梁，意义，和谈判。随着时间的推移，综合诊所的平均患者调查结果提高了0.07个单位，而其他诊所的调查得分下降了0.08个单位（p=. 02).实践意义：我们的研究探讨了一个未充分研究的因素，诊所如何能够实施改进，尽管障碍：将利益相关者内部和外部的诊所到这个过程中。它为诊所管理者提供了一个可行的路径来实施改进。
Background:How some organizations improve while others remain stagnant is a key question in health care research. Studies identifying how organizations can implement improvement despite barriers are needed, particularly in primary care.Purposes:This inductive qualitative study examines primary care clinics implementing improvement efforts in order to identify mechanisms that enable implementation despite common barriers, such as lack of time and fragmentation across stakeholder groups.Methodology:Using an embedded multiple case study design, we leverage a longitudinal data set of field notes, meeting minutes, and interviews from 16 primary care clinics implementing improvement over 15 months. We segment clinics into those that implemented more versus those that implemented less, comparing similarities and differences. We identify interpersonal mechanisms promoting implementation, develop a conceptual model of our key findings, and test the relationship with performance using patient surveys conducted pre-/post-implementation.Findings:Nine clinics implemented more successfully over the study period, whereas seven implemented less. Successfully implementing clinics exhibited the managerial practice of integrating, which we define as achieving unity of effort among stakeholder groups in the pursuit of a shared and mutually developed goal. We theorize that integrating is critical in improvement implementation because of the fragmentation observed in health care settings, and we extend theory about clinic managers’ role in implementation. We identify four integrating mechanisms that clinic managers enacted: engaging groups, bridging communication, sensemaking, and negotiating. The mean patient survey results for integrating clinics improved by 0.07 units over time, whereas the other clinics’ survey scores declined by 0.08 units on a scale of 5 (p=. 02).Practice Implications:Our research explores an understudied element of how clinics can implement improvement despite barriers: integrating stakeholders within and outside the clinic into the process. It provides clinic managers with an actionable path for implementing improvement.
登录
查看更多内容
DOI：
10.1186/s13012-015-0242-0
发表时间：
2015-04-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Nilsen P
通讯作者：
Nilsen P
影响因子：
3
作者：
Gittell, JH;Fairfield, KM;Zuckerman, J
通讯作者：
Zuckerman, J
医疗保健变化和研究差距。
影响因子：
2.5
作者：
L. Issel
通讯作者：
L. Issel
影响因子：
5.6
作者：
Burgess, Nicola;Currie, Graeme
通讯作者：
Currie, Graeme
影响因子：
3
作者：
Alexander, Jeffrey A.;Hearld, Larry R.
通讯作者：
Hearld, Larry R.