Bingham Debra, Main Elliott K
California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA 94305, USA.
J Perinat Neonatal Nurs. 2010 Jan-Mar;24(1):32-42. doi: 10.1097/JPN.0b013e3181c94a24.
Change implementation within organizations is a complex and dynamic process that is not always successful. Tailoring the implementation strategies and tactics to address the identified barriers to change is one method that has been shown to be effective. Examples of 3 broad types of interrelated strategies used by frontline leaders when implementing quality improvement (QI) projects are (1) discourse (communication), (2) education (formal and informal), and (3) data (audit). Examples of common barriers to implementation are leaders' and clinicians' knowledge, attitudes, and practices, the QI topic characteristics, and the implementation climate. External pressures from national organizations such as the National Quality Forum, the Leapfrog Group, and The Joint Commission likely facilitate change. Knowledgeable, tenacious, and creative frontline physician and nurse leaders may have the greatest impact on QI implementation effectiveness because they are the individuals who decide how the strategies and tactics will be tailored.
组织内部的变革实施是一个复杂且动态的过程，并不总是成功的。调整实施策略和战术以应对已识别的变革障碍是一种已被证明有效的方法。一线领导者在实施质量改进（QI）项目时使用的3种广泛类型的相互关联策略的示例包括：（1）话语（沟通）、（2）教育（正式和非正式）以及（3）数据（审核）。实施的常见障碍示例包括领导者和临床医生的知识、态度和做法、QI主题特征以及实施氛围。来自国家组织（如国家质量论坛、跨越组织和联合委员会）的外部压力可能会促进变革。知识渊博、坚韧且有创造力的一线医生和护士领导者可能对QI实施效果产生最大影响，因为他们是决定如何调整策略和战术的人。
