Thomas Paul, McDonnell Juliet, McCulloch Janette, While Alison, Bosanquet Nick, Ferlie Ewan
Thames Valley University and Brent Primary Care Trust, London, UK.
Ann Fam Med. 2005 Jul-Aug;3(4):312-7. doi: 10.1370/afm.309.
We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs).
Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context.
Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these "learning spaces"; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits.
These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights.
我们希望确定哪些组织特征有助于基层医疗集团（PCG）的创新。
我们的研究采用了全系统参与式行动研究模型。四个研究团队提供了互补的见解。对四个基层医疗集团案例进行了分析。其中两个进行了干预，以帮助当地协调员反思他们的工作。数据包括70次关键 informant 访谈、对临床治理干预措施和委员会会议的观察、书面材料分析、对伦敦基层医疗组织的调查和电话访谈、对20名护士的访谈以及对6名财务总监的访谈。广泛的利益相关者在年度会议上审查了数据，并就可靠原则形成了结论。根据这些结论并回应不断变化的政治背景，对连续的研究阶段进行了重新调整。
五个特征与组织创新能力的提高相关：（1）明确的结构以及公司和临床治理的愿景；（2）组织各级人员有多次反思和学习的机会，以及这些“学习空间”之间的联系；（3）临床医生和管理人员都担任鼓励参与的领导角色；（4）倡议的时机恰当并适应当地情况；（5）外部促进为人们提供了理解自身经历的机会。士气低落通常归因于三个特征：（1）改革步伐过快；（2）员工经验不足和支持性基础设施不足；（3）财政赤字。
这些特征共同作用可能有助于其他基层医疗官僚机构的创新。该研究方法使来自不同背景的人能够理解不同的研究见解。
