Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study
Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study
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DOI：
10.1136/bmjqs-2013-001947
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发表时间：
2014-02-01
影响因子：
5.4
通讯作者：
West, Michael
中科院分区：
文献类型：
--
作者：
Dixon-Woods, Mary;Baker, Richard;West, Michael
世界各地卫生系统的质量和安全问题持续存在。我们进行了一项大型研究计划，以检查英国国家医疗服务体系（NHS）的文化和行为。方法混合方法研究，包括从多个来源收集和三角测量数据，包括访谈，调查，人种学案例研究，董事会会议记录和公开可用的数据集。我们叙述性地综合了研究中的数据，以产生一个整体的画面，并在本文中提出了一个高层次的总结。结果我们发现，几乎所有人都希望提供最优质的护理。我们确定了许多亮点优秀的关怀和实践和高质量的创新在整个NHS，但也相当不一致。目标不明确，优先事项重叠，分散注意力，以及以服从为导向的官僚化管理，对持续实现高质量护理提出了挑战。制度和监管环境由多个服务不同但重叠功能的外部机构组成。一些组织发现很难对他们提供的护理质量获得有效的见解。糟糕的组织和信息系统有时会使工作人员难以有效地提供护理，并使他们无力发起改进。良好的员工支持和管理也是高度可变的，尽管它们是文化的基础，并直接关系到患者的体验，安全和护理质量。结论：我们的研究结果强调了明确、具有挑战性的目标对于高质量护理的重要性。组织需要把病人放在一切工作的中心，获得聪明的智慧，专注于改善组织系统，并通过确保员工感到被重视、尊重、参与和支持来培养关怀文化。
Background Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS).Methods Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a high-level summary.Results We found an almost universal desire to provide the best quality of care. We identified many bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care.Conclusions Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.