A qualitative study of contextual factors' impact on measures to reduce surgery cancellations
A qualitative study of contextual factors' impact on measures to reduce surgery cancellations
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DOI：
10.1186/1472-6963-14-215
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发表时间：
2014-05-13
影响因子：
2.8
通讯作者：
Bukve, Oddbjorn
中科院分区：
文献类型：
--
作者：
Hovlid, Einar;Bukve, Oddbjorn
背景：背景因素影响质量改进结果。在调整和实施干预措施以及将改进转化为新的环境时，了解这种影响非常重要。到目前为止，有有限的知识背景因素如何影响质量改进过程。在这项研究中，我们探讨了背景因素如何影响措施，以减少手术取消，这是一个长期存在的问题，在医疗保健。我们讨论的有用性的理论框架模型提供的理解成功的质量（MUSIQ）为这种research.Method：我们进行了定性的案例研究，在福尔德医院，挪威，在那里我们以前证明了减少手术取消。我们采访了20名临床医生，并进行内容分析，探讨如何上下文因素影响的措施，以减少取消计划surgery.Results：我们确定了三个共同的主题，上下文因素如何影响的变化过程：1）确定需要改变，2）促进系统范围内的改进，和3）领导的参与和支持。患者的意见有助于确定需要改变，并有助于达成改变是必要的共识。减少取消需要改善临床系统。这一改进过程基于一项战略，即强调一线临床医生参与检测和改进系统问题。临床医生通过参与改进团队来分享他们的工作信息，以更全面地了解临床系统及其相互依赖性。这种新的理解使临床医生能够检测系统问题并设计适当的干预措施。中层管理人员的参与，在改进团队和定期的工作流程是非常重要的成功实施和适应interventions.Conclusion：上下文因素相互作用，并与干预措施，以促进临床系统的变化，减少手术取消。MUSIQ框架有助于探索情境因素如何影响改进过程以及它们如何相互影响。根据理论框架讨论数据可以促进报告结果的更大一致性，促进跨研究的知识积累。
Background: Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes. In this study, we explore how contextual factors affected measures to reduce surgery cancellations, which are a persistent problem in healthcare. We discuss the usefulness of the theoretical framework provided by the model for understanding success in quality (MUSIQ) for this kind of research.Method: We performed a qualitative case study at Forde Hospital, Norway, where we had previously demonstrated a reduction in surgery cancellations. We interviewed 20 clinicians and performed content analysis to explore how contextual factors affected measures to reduce cancellations of planned surgeries.Results: We identified three common themes concerning how contextual factors influenced the change process: 1) identifying a need to change, 2) facilitating system-wide improvement, and 3) leader involvement and support. Input from patients helped identify a need to change and contributed to the consensus that change was necessary. Reducing cancellations required improving the clinical system. This improvement process was based on a strategy that emphasized the involvement of frontline clinicians in detecting and improving system problems. Clinicians shared information about their work by participating in improvement teams to develop a more complete understanding of the clinical system and its interdependencies. This new understanding allowed clinicians to detect system problems and design adequate interventions. Middle managers' participation in the improvement teams and in regular work processes was important for successfully implementing and adapting interventions.Conclusion: Contextual factors interacted with one another and with the interventions to facilitate changes in the clinical system, reducing surgery cancellations. The MUSIQ framework is useful for exploring how contextual factors influence the improvement process and how they influence one another. Discussing data in relation to a theoretical framework can promote greater uniformity in reporting findings, facilitating knowledge-building across studies.