Jones K R, Redman R W, VandenBosch T M, Holdwick C, Wolgin F
University of Michigan School of Nursing, Ann Arbor 48109-0482, USA.
Outcomes Manag Nurs Pract. 1999 Jul-Sep;3(3):128-35.
Health care organizations are rethinking how care is delivered because of incentives generated by managed care and a competitive marketplace. An evaluation of a work redesign project that involved the creation of redesigned unlicensed caregiver roles is described. The effect of model implementation on patients, multiple categories of caregivers, and physicians was measured using several different approaches to data collection. In this evaluation, caregivers perceived the institutional culture to be both market-driven and hierarchical. The work redesign, along with significant changes in unit configuration and leadership over the same period, significantly reduced job security and satisfaction with supervision. Quality indicators suggested short-term declines in quality during model implementation with higher levels of quality after implementation issues were resolved. Objective measurement of the outcomes of work redesign initiatives is imperative to assure appropriate adjustments and responses to caregiver concerns.
由于管理式医疗和竞争激烈的市场所产生的激励措施，医疗保健组织正在重新思考护理的提供方式。本文描述了一个工作重新设计项目的评估，该项目涉及创建重新设计的无执照护理人员角色。使用几种不同的数据收集方法来衡量该模式实施对患者、多类护理人员和医生的影响。在本次评估中，护理人员认为机构文化既是市场驱动的，也是等级森严的。工作重新设计，以及同期单位配置和领导层的重大变化，显著降低了工作安全感和对监督的满意度。质量指标表明，在模式实施期间质量出现短期下降，在实施问题解决后质量水平更高。对工作重新设计举措的结果进行客观衡量，对于确保对护理人员的担忧做出适当调整和回应至关重要。
