BARRIERS IN INTERVENTION CHARACTERISTICS OF CLUSTER HOSPITAL (CH) IMPLEMENTATION IN MALAYSIA: AN EXPLORATORY STUDY
BARRIERS IN INTERVENTION CHARACTERISTICS OF CLUSTER HOSPITAL (CH) IMPLEMENTATION IN MALAYSIA: AN EXPLORATORY STUDY
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马来西亚集群医院 (CH) 实施干预特征的障碍：一项探索性研究
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
N. Ibrahim
中科院分区：
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作者：
Ili Liyana Khairul Anuar;Nik DewiDelina Nik Mohd Kamil;Nur Jihan Noris;Pangie Bakit;Ng Rui Jie;N. Ibrahim
为了解决拥挤的专科医院和未充分利用的地区非专科医院之间的不平衡，马来西亚卫生部于2014年推出了集群医院（CH）。继香港和澳大利亚等医疗体系相似的国家成功实施后，CH合并医院，通过共享资源，简化服务和护理协调，建立专科和非专科医院的综合网络。进行了定性研究，探讨感知的障碍和助推器对CH实施和其可持续性的医疗服务提供者通过半结构化的焦点小组讨论和深入访谈，有目的地选择的受访者从前六个CH。访谈协议的基础上制定的实施研究的综合框架（CFIR），涵盖五个领域的干预特征，外部设置，内部设置，个人的特点，和过程。本文将只强调干预特征域中的感知障碍。共有来自不同职业的274名参与者接受了采访。对访谈进行了录音、转录和专题分析。在这一领域，实施的障碍被发现在三个结构：复杂性，设计质量和包装，和成本。强调的问题包括干预措施的设计与模糊的指导方针和政策，距离和旅行成本在一个CH，医疗记录的安全性，巨大的资金和运营成本。结果发现，调整循证干预措施需要考虑到一个组织的当地情况，以便成功实施并产生预期的结果。因此，在制定社区卫生服务可持续性战略时，应考虑到基层执行者提出的这些感知障碍并采取行动。
To address an imbalance between congested specialist hospitals and underutilised district non-specialist hospitals, Ministry of Health Malaysia introduced Cluster Hospital (CH) in 2014. Following successful implementations from countries with similar healthcare system such as Hong Kong, and Australia, CH merges hospitals to establish an integrated network of specialist and non-specialist hospitals through shared resources, streamlined services and care coordination. A qualitative study was conducted to explore perceived barriers and boosters towards CH implementation and its sustainability among healthcare providers via semi-structured focus group discussions and in-depth interviews with purposefully selected respondents from the first six CHs. An Interview protocol was developed based on Consolidated Framework for Implementation Research (CFIR) covering five domains; intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. This paper will only highlight the perceived barriers in the intervention characteristics domain. A total of 274 participants from varying professions were interviewed. Interviews were audio-recorded, transcribed and thematic analysis was performed. In this domain, barriers to implementation were found within three constructs; complexity, design quality & packaging, and cost. Issues highlighted include intervention was designed with vague guidelines & policies, distance and travel costs within a CH, medical record safety, huge capital and operating cost involved. It was found that adaptation of evidence-based interventions needs to take into account the local context of an organisation for the implementation to be successful and produce desired outcomes. Thus, these perceived barriers raised by ground-level implementers should be considered and acted upon when strategising towards CH sustainability.