Hudelson P, Cléopas A, Kolly V, Chopard P, Perneger T
Département de Médecine Communautaire, Geneva University Hospitals, 24 rue Micheli du Crest, 1211 Genève 24, Switzerland.
Qual Saf Health Care. 2008 Feb;17(1):31-6. doi: 10.1136/qshc.2006.021311.
Quality improvement in healthcare organisations requires structural reorganisation and systems reform, and also the development of an appropriate organisational "culture". Beliefs and attitudes that are thought by experts to be conducive to quality improvement in hospitals include the understanding of healthcare as a complex system, recognition of the importance of coordination of healthcare processes, a positive attitude towards medical error, adherence to the concept of continuous improvement, and a central preoccupation with the patient's welfare.
To explore the ideas about quality held by hospital-based doctors and nurses in Geneva, Switzerland.
Semi-structured interviews were conducted with 21 doctors and nurses in five hospital departments to explore their ideas about the definition of quality in healthcare, their perceptions about the main barriers to achieving quality healthcare, the factors that facilitate delivery of quality healthcare, and notions of responsibility for ensuring quality healthcare.
Thematic analysis of the interview data suggested that doctors' and nurses' ideas bear little resemblance to models of quality developed by quality experts. Study participants considered quality of care to be primarily the responsibility of individual practitioners. Quality was seen as mainly dependent on the practitioners' mastery of the technical and interpersonal aspects of care. In contrast, the healthcare system was seen primarily as a source of obstacles to good quality care, providing insufficient resources and imposing an excessive administrative burden. The paper discusses the potential implications of these ideas for the implementation of quality management initiatives.
医疗保健机构的质量改进需要进行结构重组和系统改革，同时还需要培育一种合适的组织“文化”。专家认为，有助于医院质量改进的信念和态度包括将医疗保健理解为一个复杂系统、认识到医疗保健过程协调的重要性、对医疗差错持积极态度、坚持持续改进的理念以及将患者福祉作为核心关注点。
探讨瑞士日内瓦医院医生和护士对于质量的看法。
对五个医院科室的21名医生和护士进行了半结构化访谈，以探究他们对医疗保健质量定义的看法、对实现高质量医疗保健主要障碍的认知、促进提供高质量医疗保健的因素以及确保高质量医疗保健的责任观念。
对访谈数据的主题分析表明，医生和护士的看法与质量专家提出的质量模型几乎没有相似之处。研究参与者认为医疗保健质量主要是个体从业者的责任。质量主要被视为取决于从业者对护理技术和人际方面的掌握。相比之下，医疗保健系统主要被视为高质量护理的障碍来源，提供的资源不足且行政负担过重。本文讨论了这些看法对质量管理举措实施的潜在影响。
