Hariharan Seetharaman, Dey Prasanta Kumar
The University of the West Indies, St. Augustine, Trinidad.
Int J Health Care Qual Assur. 2010;23(3):287-300. doi: 10.1108/09526861011029352.
The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance.
DESIGN/METHODOLOGY/APPROACH: The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated.
Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis.
The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit.
ORIGINALITY/VALUE: The paper focuses on a uniform model that can be applied to most intensive care units.
本文旨在开发一个全面的框架以提升重症监护病房的绩效。
设计/方法/途径：该研究通过结合因果图和逻辑框架引入了一个质量管理框架。基于其绩效确定了一个重症监护病房作为研究对象。在利益相关者的参与下，使用因果图确定未达成预期绩效的原因。利用因果图中的信息开发了一个逻辑框架，并制定了详细的项目计划。实施并评估了改进项目。
利益相关者识别出了重症监护病房的各种问题。管理绩效、组织流程和人员不足被视为主要问题。开发了一个逻辑框架来规划一个改进项目，以解决临床医生和患者提出的问题。改善基础设施、配备先进设备、维护良好的设施、基于信息技术的通信、积极主动的医生、护士和支持人员、改善患者护理以及提高药品供应被视为提升绩效的主要项目成果。所提出的框架目前正被用作持续质量改进工具，为质量改进措施提供一个可持续的规划、实施、监测和评估框架。
因果图和逻辑框架分析相结合是提升重症监护绩效的一种新颖且有效的方法。任何重症监护病房都可采用类似方法。
原创性/价值：本文聚焦于一个可应用于大多数重症监护病房的统一模型。
