Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities
Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities
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DOI：
10.1136/bmjqs-2015-004453
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发表时间：
2016-09-01
影响因子：
5.4
通讯作者：
Athanasiou, Thanos
中科院分区：
文献类型：
--
作者：
Pannick, Samuel;Sevdalis, Nick;Athanasiou, Thanos
尽管利用了从其他行业获得的既定学习，但医疗保健领域的质量改进举措可能难以超越长期趋势。出现这种情况的原因很少被详细探讨，而且常常仅仅归因于临床医生在质量改进工作中遇到的困难。在文献的叙述性回顾中，我们认为，这种以临床医生为重点，相对牺牲管理人员的做法，已被证明适得其反。临床参与并不是一个普遍的挑战；此外，有证据表明，管理人员--特别是中层管理人员--在质量改进方面也可以发挥作用。然而，管理层对质量改进干预措施的参与往往是假设的，而不是得到证实的。我们确定了影响一线员工和管理人员在质量改进中协调的具体因素，并将这些因素整合到一个新的模型中：一致性模型。我们使用这个模型来探索在最近的一次试验中实施跨学科干预，描述了不同工作人员群体的不同参与激励和障碍。临床和管理利益一致的程度可能是质量改进干预措施最终成功的重要决定因素。
Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managersparticularly middle managersalso have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.