Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):669-74. doi: 10.1177/0148607110361905.
The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" and encompasses leadership, communication, teamwork, conflict resolution, and other domains. This narrative review highlights the results of recent quantitative and qualitative studies, including studies on adherence to nutrition guidelines in the critical care setting, which demonstrate that elements of organizational culture, such as leadership support, interprofessional collaboration, and shared beliefs about the utility of guidelines, influence adherence to guideline recommendations. Outside nutrition therapy, there is emerging evidence that strategies focusing on organizational change (eg, revision of professional roles, interdisciplinary teams, integrated care delivery, computer systems, and continuous quality improvement) can favorably influence professional performance and patient outcomes. Consequently, future interventions aimed at implementing nutrition guidelines should aim to measure and take into account organizational culture, in addition to considering the characteristics of the patient, provider, and guideline. Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy.
重症监护提供者的工作环境已被证明与临床实践指南（CPG）的建议的遵守情况相关。因此，在实施指南时，考虑组织文化等背景因素可能很重要。组织文化简单地定义为“这里的做事方式”，包括领导力、沟通、团队合作、冲突解决和其他领域。本叙述性综述重点介绍了最近的定量和定性研究的结果，包括重症监护环境中营养指南的依从性研究，这些研究表明，组织文化的要素，如领导力支持、跨专业协作以及对指南实用性的共同信念，会影响对指南建议的依从性。除了营养治疗之外，还有新的证据表明，侧重于组织变革的策略（例如，修订专业角色、跨学科团队、综合护理提供、计算机系统和持续质量改进）可以有利地影响专业绩效和患者结局。因此，未来旨在实施营养指南的干预措施应旨在衡量和考虑组织文化，除了考虑患者、提供者和指南的特征。还需要高质量、多方法的研究来提高我们对文化如何影响指南实施的理解，以及哪些组织变革策略在优化营养治疗方面最有效。
