Applying the quality improvement collaborative method to process redesign: a multiple case study
Applying the quality improvement collaborative method to process redesign: a multiple case study
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DOI：
10.1186/1748-5908-5-19
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发表时间：
2010-02-25
影响因子：
7.2
通讯作者：
van Merode, Godefridus G.
中科院分区：
文献类型：
--
作者：
Vos, Leti;Duckers, Michel L. A.;van Merode, Godefridus G.
背景：尽管质量改进协作（QICs）被广泛使用，但支持这种方法的证据是有限的。QIC是一种在组织中快速测试和实施基于证据的变更的方法。为了进一步了解QIC的使用条件，我们在本研究中探讨了QIC方法在流程再设计中的适用性。方法：我们使用多案例研究设计评估了一个由17个项目团队组成的荷兰流程再设计协作。这次合作的目标是减少第一次到门诊诊所和开始治疗之间的时间，并将参与的患者群体的住院时间减少30%。使用定性方法收集数据，如文件分析、问卷调查、半结构化访谈和参与协作会议。结果：应用QIC方法进行工艺再设计是困难的。首先，项目团队没有使用提供的标准变更想法，因为他们需要定制的解决方案，这些解决方案与特定于上下文的等待时间和延迟原因相匹配。第二，项目团队没有能力在短时间内测试变更想法，这是因为：裁剪变更想法的需要和调整相关部门利益的复杂性；涉及的患者群体数量少；信息和通信技术（ICT）支持不足。第三，项目团队没有经历同伴激励，因为他们看到他们的项目之间很少有相似之处，很少分享经验，也没有表现出竞争行为。此外，许多项目团队报告说，组织和外部变更代理的支持是有限的。结论：本研究表明，需要根据当地情况调整标准变更想法，以及协调相关部门利益的复杂性阻碍了QIC方法在流程重新设计中的应用。我们无法确定QIC方法是否适用于工艺重新设计。由于外部变革主体参与项目团队的选择过程，同伴激励不是最优的。总之，项目团队认为缺乏成功使用QIC方法的必要先决条件。
Background: Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.Methods: We evaluated a Dutch process redesign collaborative of seventeen project teams using a multiple case study design. The goals of this collaborative were to reduce the time between the first visit to the outpatient's clinic and the start of treatment and to reduce the in-hospital length of stay by 30% for involved patient groups. Data were gathered using qualitative methods, such as document analysis, questionnaires, semi-structured interviews and participation in collaborative meetings.Results: Application of the QIC method to process redesign proved to be difficult. First, project teams did not use the provided standard change ideas, because of their need for customised solutions that fitted with context-specific causes of waiting times and delays. Second, project teams were not capable of testing change ideas within short time frames due to: the need for tailoring changes ideas and the complexity of aligning interests of involved departments; small volumes of involved patient groups; and inadequate information and communication technology (ICT) support. Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour. Besides, a number of project teams reported that organisational and external change agent support was limited.Conclusions: This study showed that the perceived need for tailoring standard change ideas to local contexts and the complexity of aligning interests of involved departments hampered the use of the QIC method for process redesign. We cannot determine whether the QIC method would have been appropriate for process redesign. Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent. In conclusion, project teams felt that necessary preconditions for successful use of the QIC method were lacking.