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立法性与非立法性医疗质量政策的影响:两个国家之间的比较。

The impact of legislative versus non-legislative quality policy in health care: a comparison between two countries.

作者信息

Sluijs E M, Outinen M, Wagner C, Liukko M, de Bakker D H

机构信息

Nivel, The Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.

出版信息

Health Policy. 2001 Nov;58(2):99-119. doi: 10.1016/s0168-8510(01)00144-0.

Abstract

UNLABELLED

An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown. This article explores that relationship by comparing two countries with different quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Finland, QM is not required by law and the responsibilities for organizing health care are delegated to the municipalities. The question is whether or not these differences in national policy are reflected in the extent and effectiveness of QM in health care organizations in the two countries. A cross sectional survey was conducted in late 1999. Data about QM in both countries were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health care organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and more patient participation were found in Dutch health care organizations compared with the Finnish ones. However, contrary to our expectations, the Finnish organizations reported more perceived effects of their QM-activities. Further analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvement procedures, human resource management and the flexible attitude of employees showed the strongest relationship with the perceived effects of QM. The difference between the national approach in The Netherlands and the decentralized approach in Finland did not, as we had assumed, result in more regional variation in QM in Finland.

CONCLUSIONS

a government's quality policy may have some influence on the extent of QM in health care organizations. However, more QM-activities do not necessarily imply more effects.

RECOMMENDATIONS

since QM-activities differ in the degree to which they bring about changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care.

摘要

未标注

政府质量政策的一个重要目标是促进医疗保健机构的质量管理(QM)。政府质量政策与医疗保健机构质量管理之间的关系尚不清楚。本文通过比较荷兰和芬兰这两个质量政策不同的国家来探讨这种关系。在荷兰,质量管理是法律要求,医疗保健在国家层面进行组织。在芬兰,法律不要求质量管理,组织医疗保健的责任下放给市政当局。问题是国家政策的这些差异是否反映在两国医疗保健机构质量管理的程度和效果上。1999年末进行了一项横断面调查。通过问卷调查收集了两国质量管理的数据。涉及的子部门有医院、残疾人护理和老年人护理。共有1172个医疗保健机构参与了研究(回复率64%)。结果表明——与我们的假设一致——与芬兰的医疗保健机构相比,荷兰的医疗保健机构开展的质量管理活动略多,患者参与度也更高。然而,与我们的预期相反,芬兰的机构报告称其质量管理活动的感知效果更好。进一步分析表明,一些质量管理活动与质量管理效果的关联比其他活动更紧密。特别是,循环质量改进程序、人力资源管理和员工的灵活态度与质量管理的感知效果关系最为密切。正如我们所假设的,荷兰的国家方法与芬兰的分散方法之间的差异并没有导致芬兰质量管理在区域上有更多差异。

结论

政府的质量政策可能对医疗保健机构质量管理的程度有一定影响。然而,更多的质量管理活动并不一定意味着有更多效果。

建议

由于质量管理活动在带来护理方面的变化和改进的程度上存在差异,建议政策制定者推广那些最有效的质量管理活动,以提高护理质量。

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