Perceptions of Factors Associated With Inclusive Work and Learning Environments in Health Care Organizations A Qualitative Narrative Analysis
Perceptions of Factors Associated With Inclusive Work and Learning Environments in Health Care Organizations A Qualitative Narrative Analysis
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DOI：
10.1001/jamanetworkopen.2018.1003
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发表时间：
2018-08-01
影响因子：
13.8
通讯作者：
Higginbotham, Eve
中科院分区：
文献类型：
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作者：
Aysola, Jaya;Barg, Frances K.;Higginbotham, Eve
重要性医疗保健工作人员的多样化仍然是医疗保健组织的一个关键目标，重点是减少护理方面的差距。然而，它仍然是未知的因素创造包容性的卫生系统环境，并帮助组织保留一个多元化的workworld.Objective了解从医疗保健劳动力的成员是什么因素有助于包容性的工作和学习环境，以及可以做些什么来提高医疗保健组织内的包容性。和参与者对2016年6月1日，8日，15日和22日发送的医疗保健组织内的每周电子邮件叙事的响应进行定性叙事分析。该电子邮件包含一个匿名链接，链接到2个开放式刺激问题，要求提供反映参与者工作环境中包容性或缺乏包容性的故事以及人口统计学问题。这项研究在6家医院进行，包括一家独立的儿童医院和一家退伍军人事务医疗中心，4所健康科学学校（医学，护理，牙科和社会政策与实践），以及宾夕法尼亚州一所大学医疗保健系统内的门诊设施。共有315份完整的叙述，来自卫生保健系统管理人员（n = 3），工作人员（n = 113），学术教师（n = 97），学员或学生（n = 99），以及3名拒绝指定其职位的人。以及改善环境包容性的建议。结果在医疗保健系统成员提交的315份叙述中，有188人（59.7%）自认为是女性;有10人（3.2%）。变性人/同性恋者; 38人（12.1%）为非西班牙裔黑人; 152人（48.3%）为非基督徒; 31人（9.8%）以英语以外的语言为主要语言; 14人（4.4%）有残疾。对叙述的分析揭示了影响医疗保健组织内包容性的6个主要因素：（1）歧视的存在;（2）沉默的证人;（3）等级制度、认可和文明的相互作用;（4）组织领导和导师的有效性;（5）对工作与生活平衡的支持;（6）对包容性努力的排斥感。包容性方面的挑战对工作业绩和福祉产生了负面影响，据报告，压力、焦虑和绝望感。大多数受访者提到了一个系统的文化，影响他们的人际动态，并提供了具体的战略，以改善组织文化，重点是领导能力的培训和扩大collegialnetworks.Conclusions和相关性这种叙事分析提供了一个分类的因素，卫生保健组织可以用来评估包容在他们的学习和工作环境，以及战略，以提高包容性和保持多样化的健康护理劳动力。
IMPORTANCE Diversifying the health care workforce remains a critical goal for health care organizations focused on reducing disparities in care. However, it remains unknown what factors create inclusive health system environments and help organizations retain a diverse workforce.OBJECTIVE To understand from members of the health care workforce what factors contribute to inclusive work and learning environments and what can be done to improve inclusion within health care organizations.DESIGN, SETTING, AND PARTICIPANTS A qualitative narrative analysis of responses to a weekly email call for narratives within health care organizations sent June 1, 8, 15, and 22, 2016. The email contained an anonymous link to 2 open-ended stimulus questions asking for stories reflecting inclusion or lack thereof within participants' work environments as well as demographic questions. The study took place at 6 hospitals, including a free-standing children's hospital and a Veterans Affairs medical center, 4 health sciences schools (Medicine, Nursing, Dental, and Social Policy and Practice), and outpatient facilities within a university-based health care system in Pennsylvania. There were 315 completed narratives submitted from health care system executives (n = 3), staff (n = 113), academic faculty (n = 97), trainees or students (n = 99), and 3 who declined to specify their positions.MAIN OUTCOMES AND MEASURES Workplace experiences with inclusivity, implications of these experiences, and recommendations to improve inclusion within environments.RESULTS Of 315 narratives submitted from members of the health care system, in 188 (59.7%)the writer self-identified as female; in 10 (3.2%). as transgender/queer; in 38 (12.1%), as non-Hispanic black; in 152 (48.3%), as non-Christian; in 31(9.8%), as having a language other than English as their primary language; and in 14 (4.4%), as having a disability. Analysis of the narratives revealed 6 broad factors that affected inclusion within health care organizations: (1) the presence of discrimination; (2) the silent witness; (3) the interplay of hierarchy, recognition, and civility; (4) the effectiveness of organizational leadership and mentors; (5) support for work-life balance; and (6) perceptions of exclusion from inclusion efforts. Challenges with inclusion had negative effects on job performance and well-being, with reports of stress, anxiety, and feelings of hopelessness. Most respondents referenced a systemic culture that influenced their interpersonal dynamics and provided specific strategies to improve organizational culture that focused on leadership training and expanding collegial networks.CONCLUSIONS AND RELEVANCE This narrative analysis provides a taxonomy of factors that health care organizations can use to assess inclusion within their learning and work environments as well as strategies to improve inclusion and retain a diverse health care workforce.