Improvement, trust, and the healthcare workforce
Improvement, trust, and the healthcare workforce
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DOI：
10.1136/qhc.12.6.448
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发表时间：
2003-12-01
影响因子：
--
通讯作者：
Berwick, DM
中科院分区：
文献类型：
--
作者：
Berwick, DM
尽管医疗保健系统表现中的主要缺陷有充分的记录，但补救的进展仍然缓慢。加速改善将需要对发展医疗保健人力的态度和战略的重大转变。目前，流行的战略主要依赖于过时的控制和工作标准化理论。更现代、更有效的生产理论试图利用劳动力的想象力和参与度来重塑这一体系。这就要求工作人员能够设定大胆的目标，测量进度，为工作本身找到可选择的设计，并快速且有信息地测试变更。它还需要多种形式的高度信任，对团队合作的偏见，以及对承担改进负担的偏好，而不是责怪外部因素。建立在这些原则基础上的新的医疗保健人力战略将比目前产生更快的改善。
Although major defects in the performance of healthcare systems are well documented, progress toward remedy remains slow. Accelerating improvement will require large shifts in attitudes toward and strategies for developing the healthcare workforce. At present, prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce in reinventing the system. This requires a workforce capable of setting bold aims, measuring progress, finding alternative designs for the work itself, and testing changes rapidly and informatively. It also requires a high degree of trust in many forms, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. A new healthcare workforce strategy, founded on these principles, will yield much faster improvement than at present.