The York Management School, The University of York, York, UK.
J Eval Clin Pract. 2011 Feb;17(1):111-7. doi: 10.1111/j.1365-2753.2010.01376.x. Epub 2010 Sep 2.
The growing interest in patient-focused health care in the National Health System (NHS), especially in the wake of high-profile failures in clinical practice, has underlined the need to involve patients in the design and evaluation of organizational change management programmes at the local level. This includes an evaluation of the relevance of culture and how culture might be assessed and managed in the delivery of high-quality and safe care. The purpose of this study is to compare and contrast the perspectives of health care professionals and patient representatives on purposeful attempts to manage culture change in the English NHS.
We used the mixed approach, but with more quantitative than qualitative data. A postal questionnaire survey of clinical governance leads and patient representatives from 276 NHS trusts was followed up with a focus group discussion of eight of the survey participants and semi-structured interviews with 18, including health care professionals and patient representatives from various organizations. We used spss to analyse the survey data and Atlas.ti to analyse the qualitative data.
Both clinical governance leads and patient representatives considered culture management and change to be integral to quality and safety improvement efforts. However, clinical governance leads were more positive than patient representatives about anticipated results from ongoing efforts to manage culture change at the local level. Further, in spite of general agreement on various attributes for culture assessment efforts, there was a striking difference in the level of importance respondents attached to blame free (more important to clinical governance managers) and customization (more important to patient representatives).
国民医疗服务体系（NHS）对以患者为中心的医疗保健日益关注，尤其是在临床实践中出现备受瞩目的失败后，这凸显了在地方层面上让患者参与组织变革管理计划的设计和评估的必要性。这包括评估文化的相关性以及如何在提供高质量和安全护理的过程中评估和管理文化。本研究的目的是比较和对比医疗保健专业人员和患者代表对英国国民医疗服务体系中有意管理文化变革的观点。
我们采用了混合方法，但定量数据多于定性数据。对 276 家 NHS 信托的临床治理负责人和患者代表进行了邮政问卷调查，随后对 8 名调查参与者进行了焦点小组讨论，并对包括来自不同组织的医疗保健专业人员和患者代表在内的 18 人进行了半结构化访谈。我们使用 spss 分析调查数据，使用 Atlas.ti 分析定性数据。
临床治理负责人和患者代表都认为文化管理和变革是质量和安全改进工作的组成部分。然而，与患者代表相比，临床治理负责人对正在进行的地方层面文化变革管理工作的预期结果更为乐观。此外，尽管对文化评估工作的各种属性普遍达成一致，但受访者对无责（对临床治理经理更重要）和定制（对患者代表更重要）的重视程度存在显著差异。
