Dixon-Woods M, Tarrant C, Willars J, Suokas A
Social Science Research Group, Department of Health Sciences, University of Leicester, Adrian Building, Leicester LE1 7RH, UK.
Qual Saf Health Care. 2010 Feb;19(1):74-8. doi: 10.1136/qshc.2008.029504.
Implementation of quality improvement programmes may suffer if the stakeholders involved do not share a common understanding of the theory of change or do not accept it as legitimate. We aimed to identify how strategic stakeholders understood and responded to the first phase of the Health Foundation's Safer Patients Initiative, a programme aimed at making hospitals safer for patients in the UK.
Semistructured telephone interviews were conducted with 60 strategic-level hospital stakeholders and with five stakeholders involved in commissioning, designing and introducing the initiative. Analysis was based on the constant comparative method.
The aims of the initiative were seen as legitimate and sound by most hospital stakeholders, and the theory of change was generally understood and accepted, but seven hospital stakeholders were unable to describe it. Although participants had specific doubts, particularly relating to feasibility of implementation and scientific legitimacy of some elements of the initiative, overall there was a broadly shared vision and commitment to the principles and practices associated with the theory of change, and considerable enthusiasm and optimism. Contestations about the legitimacy and relevance of the initiative among front-line staff, local resistance to changes that went against established norms, and resource and structural issues were, however, seen as potentially threatening to implementation.
It is possible to get strategic-level individuals, even when widely dispersed, to understand and agree upon a theory of change that can be used in their organisations. These individuals are also able to recognise the contexts of negotiation in which programmes of change are enacted.
如果参与的利益相关者对变革理论没有共同的理解，或者不认为其合理合法，那么质量改进计划的实施可能会受到影响。我们旨在确定战略利益相关者如何理解并回应健康基金会的“更安全患者倡议”的第一阶段，该倡议旨在使英国的医院对患者更安全。
对60名医院战略层面的利益相关者以及5名参与该倡议委托、设计和引入工作的利益相关者进行了半结构化电话访谈。分析基于持续比较法。
大多数医院利益相关者认为该倡议的目标合理且可行，变革理论总体上得到理解和接受，但有7名医院利益相关者无法描述该理论。尽管参与者有具体疑虑，特别是关于实施的可行性和该倡议某些要素的科学合理性，但总体上对与变革理论相关的原则和实践有着广泛共同的愿景和承诺，并且热情高涨、充满乐观。然而，一线工作人员对该倡议的合理性和相关性的争论、当地对违背既定规范的变革的抵制，以及资源和结构问题，被视为可能对实施构成威胁。
即使战略层面的人员分布广泛，也有可能让他们理解并认同一种可在其组织中使用的变革理论。这些人员也能够认识到实施变革计划时的谈判背景。
