Balancing participation and expertise: A comparison of locally and centrally managed health care quality improvement within primary care practices
Balancing participation and expertise: A comparison of locally and centrally managed health care quality improvement within primary care practices
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DOI：
10.1177/1049732307307447
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发表时间：
2007-11-01
影响因子：
3.2
通讯作者：
Meredith, Lisa S.
中科院分区：
文献类型：
--
作者：
Parker, Louise E.;de Pillis, Emmeline;Meredith, Lisa S.
在一项纵向定性研究中，作者评估了两种强调参与（局部方法）或专业知识（中央方法）的医疗保健质量改进（QI）方法。他们多年来跟踪使用这些方法为初级保健实践制定抑郁症护理 QI 项目的团队，观察其过程和结果，并了解参与者的看法、信念和经验。与文献一致，大多数参与者更喜欢当地方法，但有些人愿意将一些决策权交给专家。参与者确定了本地方法（例如，最大化支持和本地适应性）和中央方法（例如，最大化效率、减轻负担）的独特优势。作者提出了一种混合模型，其中专家对采用哪些实践做出战略决策，而本地站点人员对实施做出战术决策。他们认为，平衡参与和专业知识为医疗保健组织在各种情况下产生持久的 QI 提供了最佳方案。
In a longitudinal qualitative study, the authors evaluated two health care quality improvement (QI) methods that emphasized either participation (local approach) or expertise (central approach). They followed teams using these approaches to develop depression care QI programs for primary care practices over several years, observing their processes and outcomes and learning about participants' perceptions, beliefs, and experiences. Concordant with the literature, most participants preferred the local approach, but some were willing to relinquish some decision making to experts. Participants identified unique advantages of both the local (e.g., maximizes buy-in and local fit) and central (e.g., maximizes efficiency, reduces burden) approaches. The authors propose a hybrid model in which experts make strategic decisions about what practices to adopt and local site personal make tactical decisions about implementation. They believe that balancing participation and expertise provides the best formula for producing lasting QI for health care organizations across a wide variety of circumstances.