The Science of Quality Improvement Implementation Developing Capacity to Make a Difference
The Science of Quality Improvement Implementation Developing Capacity to Make a Difference
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DOI：
10.1097/mlr.0b013e3181e1709c
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发表时间：
2011-12-01
期刊：
影响因子：
3
通讯作者：
Hearld, Larry R.
中科院分区：
文献类型：
--
作者：
Alexander, Jeffrey A.;Hearld, Larry R.
背景：质量改进（QI）有望提高护理质量;然而，组织往往难以实施。它已被建议，从业者，管理者和研究人员试图增加的结构，实践和组织，促进或阻碍QI innovations.Objectives的实施情况的背景下系统的理解：批判性地回顾QI在医疗保健组织实施的实证研究。研究设计：107项研究的文献综述，研究了医疗保健组织实施QI创新的情况。研究被分为4组的基础上，被假定为影响实施（QI创新，组织流程，内部环境，和外部contextuals）的内容的预测因素的类型。结果：内部环境和组织流程是最经常研究的类别。外部环境和组织过程类别表现出最高的积极影响率QI implementation.Conclusions：审查发现了几个重要的差距，在QI实施文献。研究往往缺乏明确的概念框架来指导研究，这可能会阻碍比较各项研究之间关系的努力。研究还倾向于采用狭隘地侧重于预测因素的独立影响的设计，而不包括全面的框架来捕捉执行过程中所涉及的许多因素之间的相互作用。其他设计限制包括使用横断面设计、单一来源数据收集和研究参与者之间的潜在选择偏倚。
Background: Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations.Objectives: To critically review the empirical research on QI implementation in health care organizations.Research Design: A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context).Results: Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation.Conclusions: The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.