Rangachari Pavani
School of Health Sciences, Medical College of Georgia, Augusta, Georgia 30912, USA.
Qual Manag Health Care. 2010 Jan-Mar;19(1):34-46. doi: 10.1097/QMH.0b013e3181ccbd1d.
Recently, hospitals that have been successful in preventing infections have labeled their improvement approaches as either the Toyota Production System (TPS) approach or the Positive Deviance (PD) approach. PD has been distinguished from TPS as being a bottom-up approach to improvement, as against top-down. Facilities that have employed both approaches have suggested that PD may be more effective than TPS for infection prevention. This article integrates organizational learning, institutional, and knowledge network theories to develop a theoretical framework for understanding the structure and evolution of effective knowledge-sharing networks in health care organizations, that is, networks most conducive to learning and improvement. Contrary to arguments put forth by hospital success stories, the framework suggests that networks rich in brokerage and hierarchy (ie, top-down, "TPS-like" structures) may be more effective for learning and improvement in health care organizations, compared with a networks rich in density (ie, bottom-up, "PD-like" structures). The theoretical framework and ensuing analysis help identify several gaps in the literature related to organization learning and improvement in the infection prevention context. This, in turn, helps put forth recommendations for health management research and practice.
最近，在预防感染方面取得成功的医院将其改进方法标记为丰田生产系统（TPS）方法或积极偏差（PD）方法。PD与TPS的区别在于它是一种自下而上的改进方法，而TPS是自上而下的方法。采用这两种方法的机构表明，在预防感染方面，PD可能比TPS更有效。本文整合了组织学习、制度和知识网络理论，以建立一个理论框架，用于理解医疗保健组织中有效知识共享网络的结构和演变，即最有利于学习和改进的网络。与医院成功案例中提出的观点相反，该框架表明，与密度高的网络（即自下而上的“类似PD”结构）相比，具有丰富中介和层级的网络（即自上而下的“类似TPS”结构）可能在医疗保健组织的学习和改进方面更有效。该理论框架及后续分析有助于找出文献中与感染预防背景下的组织学习和改进相关的几个差距。反过来，这有助于为健康管理研究和实践提出建议。
