Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.
Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.
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DOI：
10.1111/jep.12438
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发表时间：
2016-02
影响因子：
2.4
通讯作者：
Siriwardena AN
中科院分区：
文献类型：
--
作者：
Phung VH;Essam N;Asghar Z;Spaight A;Siriwardena AN
临床领导和组织文化是质量改进（QI）的重要背景因素，但它们与组织变革之间的关系复杂且知之甚少。我们的目的是在全国救护车QI协作（QIC）中探索临床领导，创新文化和临床参与QI之间的关系。我们使用了一份自我管理的在线问卷调查，发送给所有12个英国救护车服务的一线临床医生。我们对定量数据进行了横断面分析，并对自由文本回复进行了定性分析。在12个参与调查的救护车服务机构中，有11个机构回复了2743份（占22117份的12%）。在直接参与QIC的3%应答者中，领导行为显著高于没有直接参与QIC的应答者。QIC参与对应答者对其组织创新文化的看法没有显著差异，通常被认为是差的。虽然整体上对QI方法的接受程度较低，但QIC成员更有可能使用QI方法，这也与领导行为显著相关。尽管创新、临床领导和在救护车服务中普遍使用QI方法的组织文化有限，但QIC实现了其显著改善急性心肌梗死和中风院前护理的目标。我们假设这是通过与QIC相关的改进亚文化介导的，该亚文化通过刺激领导力和QI方法促进了大规模的改进。需要进一步的研究来了解在复杂的卫生保健环境中QI的成功因素。
Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments.
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发表时间：
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