Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics.
Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics.
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DOI：
10.1186/s12939-018-0820-2
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发表时间：
2018-09-27
影响因子：
4.8
通讯作者：
Blanchet Garneau A
中科院分区：
文献类型：
--
作者：
Browne AJ;Varcoe C;Ford-Gilboe M;Nadine Wathen C;Smye V;Jackson BE;Wallace B;Pauly BB;Herbert CP;Lavoie JG;Wong ST;Blanchet Garneau A
在全球社会和保健不平等现象日益扩大的背景下，保健部门在促进公平方面可发挥重要作用。本文的目的是说明实施组织层面的卫生公平干预的过程和影响，旨在提高提供以公平为导向的卫生保健的能力。被称为“EQUIP”的理论知情和循证干预措施包括对工作人员的教育内容，并整合了以公平为导向的护理的三个关键维度：文化安全、创伤和暴力知情护理以及因地施策。干预措施是在四个加拿大初级保健诊所实施的，这些诊所致力于为边缘化人群服务，包括生活贫困的人、无家可归的人以及遭受严重创伤的人，包括土著人民、新移民和难民。使用混合方法设计来检查干预对诊所组织流程和优先事项以及对员工的影响。参与EQUIP干预措施提高了工作人员对以公平为导向的保健的认识和信心。重要的是，EQUIP干预措施暴露出的紧张局势反映了更广泛社区的紧张局势，包括与种族主义、暴力和创伤的影响以及药物使用问题有关的紧张局势。这些紧张关系的浮现是破坏性的，但导致了集中的组织战略，例如：努力解决结构和人际种族主义；改善候诊室环境；改变组织政策和做法以支持减少伤害。通过让所有工作类别的工作人员参与进来，编写关于所服务社区和人口的社会历史背景的叙述，并向诊所反馈有关患者群体中关键健康问题的数据（例如，抑郁程度、创伤症状和慢性疼痛），增强了干预措施的影响。然而，与对复杂干预措施的批评一致，EQUIP可能没有发挥最大的破坏性作用。组织特征（如资金和领导）和提供干预措施的特征（如时间框架和谁提供了干预措施的组成部分）塑造了过程和影响。这一分析表明，组织应该预测和计划各种类型的中断，同时最大化组织内部人员对干预的所有权机会。我们的研究结果进一步表明，以公平为导向的干预措施应在相对较短的时间框架内密集实施，并进行评估，特别是根据可以持续获得的数据进行评估，并明确包括减少伤害的视角。
The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. The theoretically-informed and evidence-based intervention known as ‘EQUIP’ included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics’ organizational processes and priorities, and on staff. Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.
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影响因子：
5.4
作者：
Browne, Annette J.
通讯作者：
Browne, Annette J.
影响因子：
4.8
作者：
Browne, Annette J.;Varcoe, Colleen M.;Lennox, Scott
通讯作者：
Lennox, Scott
影响因子：
3.5
作者：
Lavoie, Josee;Boulton, Amohia;Dwyer, Judith
通讯作者：
Dwyer, Judith
影响因子：
1.3
作者：
Lavoie, Josee G.;Browne, Annette J.;Tu, David
通讯作者：
Tu, David
影响因子：
4.8
作者：
Browne AJ;Varcoe C;Ford-Gilboe M;Wathen CN;EQUIP Research Team
通讯作者：
EQUIP Research Team