Brannon S Diane, Kemper Peter, Barry Theresa
Center for Health Care and Policy Research, The Pennsylvania State University, University Park, USA.
Health Care Manage Rev. 2009 Jul-Sep;34(3):284-93. doi: 10.1097/HMR.0b013e31819ca92b.
Better Jobs Better Care was a five-state direct care workforce demonstration designed to change policy and management practices that influence recruitment and retention of direct care workers, problems that continue to challenge providers.
One of the projects, the North Carolina Partner Team, developed a unified approach in which skilled nursing, home care, and assisted living providers could be rewarded for meeting standards of workplace excellence. This case study documents the complex adaptive system agents and processes that coalesced to result in legislation recognizing the North Carolina New Organizational Vision Award.
We used a holistic, single-case study design. Qualitative data from project work plans and progress reports as well as notes from interviews with key stakeholders and observation of meetings were coded into a simple rubric consisting of characteristics of complex adaptive systems.
Key system agents in the state set the stage for the successful multistakeholder coalition. These included leadership by the North Carolina Department of Health and Human Services and a several year effort to develop a unifying vision for workforce development. Grant resources were used to facilitate both content and process work. Structure was allowed to emerge as needed. The coalition's own development is shown to have changed the context from which it was derived.
An inclusive and iterative process produced detailed standards and measures for the voluntary recognition process. With effective facilitation, the interests of the multiple stakeholders coalesced into a policy response that encourages practice changes. Implications for managing change-oriented coalitions are discussed.
“优质工作，优质护理”是一项在五个州开展的直接护理劳动力示范项目，旨在改变影响直接护理人员招聘和留用的政策及管理做法，这些问题一直困扰着服务提供者。
其中一个项目，即北卡罗来纳州合作伙伴团队，制定了一种统一方法，熟练护理、家庭护理和辅助生活服务提供者若达到卓越工作场所标准，便可获得奖励。本案例研究记录了复杂适应系统的主体和过程，这些主体和过程共同促成了一项认可北卡罗来纳州新组织愿景奖的立法。
我们采用了整体单案例研究设计。来自项目工作计划和进度报告的定性数据，以及与关键利益相关者访谈的记录和会议观察结果，被编码到一个由复杂适应系统特征组成的简单分类体系中。
该州的关键系统主体为成功的多利益相关者联盟奠定了基础。这些主体包括北卡罗来纳州卫生与公众服务部的领导作用，以及为制定劳动力发展统一愿景所做的数年努力。拨款资源用于推动内容和流程工作。根据需要允许结构自然形成。联盟自身的发展改变了其产生的背景。
一个包容且迭代的过程为自愿认可过程制定了详细的标准和措施。通过有效的推动，多个利益相关者的利益凝聚成一项鼓励实践变革的政策回应。文中讨论了管理面向变革的联盟的意义。
