da Silva V L, Steinberg B
Kaiser Permanente Medical Center, Kensington, MD.
J Ambul Care Manage. 1991 Oct;14(4):68-76. doi: 10.1097/00004479-199110000-00013.
The tool presented here is useful in analyzing the constraints and capabilities of a health care telephone service. It also provides a systematic method for assessing systems problems. As part of our analysis, we recommended that the manager implement the following steps. First, the manager determines whether the driving force on the unit is continuity of care by an individual provider or consistency of response. This focus directly affects how the unit's telephone service can be best organized (i.e., decentralized or centralized) and clarifies the factors most needed for success. For example, to function effectively and efficiently, a centralized phone service needs strong provider-endorsed protocols. Second, the manager should carefully examine neutral constraint factors to determine methods to transform these constraints into capabilities, such as planning for extra staff or office hours (or both) during influenza season. Planning for extra hours or staff depends largely on whether budget and resource planning is done in advance and whether value is placed on customer access and satisfaction during peak demand periods. The manager must next determine whether the service delivery format (centralized or decentralized) is consistent with the force field analysis findings. If the findings are not consistent, can the analysis present a compelling argument for using the opposite approach? Finally, the manager must create a plan of action for minimizing the constraints revealed and maximizing existing capabilities to achieve the overall goal of excellent phone service. The process of analysis and creating a plan of action is an excellent opportunity to involve staff, providers, and administrators in efforts to achieve better health care telephone service for all customers.
本文介绍的工具对于分析医疗保健电话服务的限制因素和能力很有用。它还提供了一种评估系统问题的系统方法。作为我们分析的一部分，我们建议管理人员采取以下步骤。首先，管理人员要确定该部门的驱动力是个别提供者的护理连续性还是响应的一致性。这种关注点直接影响该部门的电话服务如何能得到最佳组织（即分散式或集中式），并明确成功最需要的因素。例如，为了有效且高效地运作，集中式电话服务需要强有力的、得到提供者认可的规程。其次，管理人员应仔细审查中性约束因素，以确定将这些约束转化为能力的方法，比如在流感季节安排额外的工作人员或办公时间（或两者都安排）。安排额外的时间或工作人员很大程度上取决于预算和资源规划是否提前进行，以及在需求高峰期是否重视客户接入和满意度。接下来，管理人员必须确定服务提供形式（集中式或分散式）是否与力场分析结果一致。如果结果不一致，分析能否提出令人信服的理由来采用相反的方法？最后，管理人员必须制定一项行动计划，以尽量减少所发现的约束因素，并最大限度地发挥现有能力，以实现优质电话服务的总体目标。分析和制定行动计划的过程是让工作人员、提供者和管理人员参与努力，为所有客户提供更好的医疗保健电话服务的绝佳机会。
