Russell Nicholas C C, Wallace Louise M, Ketley Diane
Applied Research Centre in Health and Lifestyle Interventions, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
Health Serv Manage Res. 2011 Nov;24(4):182-9. doi: 10.1258/hsmr.2011.011010.
The National Health Service (NHS) in England, as with other health services worldwide, currently faces the need to reduce costs and to improve the quality of patient care. Evidence gathered through effective and appropriate measurement and evaluation, is essential to achieving this. Through interviews with service improvement managers and analysis of comments in a seminar of NHS staff involved in health service improvement, we found a lack of understanding regarding the definition and methodology of both measurement and evaluation, which decreases the likelihood that NHS staff will be competent to commission or provide these skills. In addition, we highlight the importance of managers assessing their organizations' 'readiness' to undergo change before embarking on a quality improvement (QI) initiative, to ensure that the initiative's impact can be adequately judged. We provide definitions of measurement for improvement and of evaluation, and propose a comparative framework from which to gauge an appropriate approach. Examples of two large-scale QI initiatives are also given, along with descriptions of some of their problems and solutions, to illustrate the use of the framework. We recommend that health service managers use the framework to determine the most appropriate approach to evaluation and measurement for improvement for their context, to ensure that their decisions are evidence based.
与全球其他医疗服务机构一样，英国国家医疗服务体系（NHS）目前面临着降低成本和提高患者护理质量的需求。通过有效且恰当的测量与评估收集的证据，对于实现这一目标至关重要。通过对服务改进经理的访谈以及对参与医疗服务改进的NHS工作人员研讨会中的评论进行分析，我们发现对于测量和评估的定义及方法缺乏理解，这降低了NHS工作人员能够胜任委托或提供这些技能的可能性。此外，我们强调管理者在开展质量改进（QI）举措之前评估其组织接受变革的“准备程度”的重要性，以确保能够充分判断该举措的影响。我们给出了用于改进的测量和评估的定义，并提出了一个比较框架，用以衡量合适的方法。还给出了两个大规模QI举措的例子，以及对它们一些问题和解决方案的描述，以说明该框架的应用。我们建议医疗服务管理者使用该框架来确定适合其环境的用于改进的评估和测量的最恰当方法，以确保他们的决策基于证据。
