Ovretveit John
The Karolinska Institute Medical Management Centre, Stockholm, Sweden.
J Health Organ Manag. 2005;19(6):413-30. doi: 10.1108/14777260510629661.
To provide research-informed guidance to leaders of quality and safety improvement and evidence-based materials for education programmes for leaders
DESIGN/METHODOLOGY/APPROACH: Search of databases and hard copy literature since 1985 into managers' and leaders' role in quality and safety improvement. Classification into "eA": Empirical research strong evidence, "eB": Empirical research, weak evidence and, "eC": Conceptual discussion, not based on systematic empirical research. Summary, and synthesis of the best available evidence for a guidance checklist for leaders.
Although most literature emphasises the importance of committed leadership for successful quality and safety improvement, research evidence supporting this is scarce and often scientifically limited. The research shows evidence of the limitations and scope of leader actions for improving health care provision, the need to engage clinicians in this work and ways to do so, as well as the leadership role played by others apart from senior leaders. The ability of managers and other leaders skilfully to tailor Q&SI to the situation may be important but descriptions of how leaders do this and evidence supporting this proposition are lacking.
RESEARCH LIMITATIONS/IMPLICATIONS: More research is needed about whether or how the leader role is different according to the stage of quality and safety development of the organisation, the type of organisation, the type of context, the level and type of leader and the type of improvement and improvement method.
Implications for leaders' actions are provided in a "best evidence guidance" checklist. This provides more tangible and research-informed guidance than the inspirational literature or studies from single organisations.
ORIGINALITY/VALUE: This paper provides the first overview and synthesis of a wide range of studies which can be used as a basis for future research and materials for educational programmes. It provides the first detailed guidance for leaders about specific actions which research suggests they need to take to improve quality and safety.
为质量与安全改进工作的领导者提供基于研究的指导，并为领导者教育项目提供循证材料。
设计/方法/途径：检索自1985年以来的数据库及纸质文献，以了解管理者和领导者在质量与安全改进中的作用。分为“eA”：实证研究，有力证据；“eB”：实证研究，薄弱证据；“eC”：概念性讨论，非基于系统实证研究。对领导者指导清单的最佳现有证据进行总结和综合。
尽管大多数文献强调坚定的领导力对成功的质量与安全改进的重要性，但支持这一点的研究证据稀少且往往在科学上存在局限性。研究显示了领导者在改善医疗服务方面行动的局限性和范围、让临床医生参与此项工作的必要性及方式，以及除高层领导者外其他人员所发挥的领导作用。管理者和其他领导者根据具体情况巧妙调整质量与安全改进工作的能力可能很重要，但缺乏关于领导者如何做到这一点的描述以及支持这一观点的证据。
研究局限性/启示：需要更多研究来探讨领导者角色是否以及如何因组织的质量与安全发展阶段、组织类型、背景类型、领导者级别和类型以及改进类型和改进方法而有所不同。
在“最佳证据指导”清单中提供了对领导者行动的启示。这比鼓舞人心的文献或单个组织的研究提供了更具体且基于研究的指导。
原创性/价值：本文首次对广泛的研究进行了概述和综合，可作为未来研究的基础和教育项目的材料。它首次为领导者提供了关于研究表明他们为提高质量和安全需要采取的具体行动的详细指导。
