Weeks William Brinson, Mills Peter Donald, Waldron Julia, Brown Steven Holloway, Speroff Theodore, Coulson Lewis R
Dartmouth Medical School, Hanover, New Hampshire, USA.
J Healthc Manag. 2003 Jul-Aug;48(4):252-61; discussion 262.
In response to external and internal customer dissatisfaction and in anticipation of markedly higher volumes of examination requests, the Department of Veterans Affairs (VA) produced an eight-month facilitated quality-improvement project designed to improve the quality and timeliness of compensation examination processing. To determine whether participation in the project was associated with better outcomes and to identify team characteristics that were associated with high performance, we obtained centrally collected facility-level performance measures on quality and timeliness of the examinations. To determine factors associated with team success, we compared measures of leadership support reported by teams with high and low performance outcomes. Thirty teams representing 34 VA medical centers and 22 Veterans Benefits Administration's regional offices participated in the project. Monthly volumes were significantly higher for participating teams, and volumes increased significantly over time for both groups. At the beginning of the project, examination timeliness was substantially worse for participating teams (34.1 versus 29.9 days, p = .03); by the end, participants had better performance (28.5 versus 30.3 days, p = .00). Quality measures were maintained. By the end of the project, high performers reported improved leadership, frontline support, resource availability, alignment with strategic goals, and leadership mandate when compared to performance at the beginning of the project; low performers reported the opposite. These results suggest that the principles of clinical improvement can be applied successfully to teach teams how to achieve process improvements within a large healthcare organization. Visible, ongoing support by leadership and alignment of project objectives with strategic goals are associated with improved project outcomes.
为应对外部和内部客户的不满，并预期检查请求量将显著增加，美国退伍军人事务部（VA）开展了一个为期八个月的促进质量改进项目，旨在提高伤残检查处理的质量和及时性。为了确定参与该项目是否会带来更好的结果，并识别与高绩效相关的团队特征，我们获取了集中收集的关于检查质量和及时性的机构层面绩效指标。为了确定与团队成功相关的因素，我们比较了绩效结果高和低的团队报告的领导支持指标。代表34个VA医疗中心和22个退伍军人福利管理局地区办公室的30个团队参与了该项目。参与项目的团队每月的检查量显著更高，并且两组的检查量都随时间显著增加。在项目开始时，参与项目的团队的检查及时性明显更差（34.1天对29.9天，p = 0.03）；到项目结束时，参与项目的团队表现更好（28.5天对30.3天，p = 0.00）。质量指标得以维持。到项目结束时，与项目开始时的表现相比，高绩效团队报告称领导能力、一线支持、资源可用性、与战略目标的一致性以及领导授权都有所改善；低绩效团队则报告了相反的情况。这些结果表明，临床改进原则可以成功应用于教导团队如何在大型医疗组织内实现流程改进。领导的明显持续支持以及项目目标与战略目标的一致性与改善项目结果相关。
