Perla Rocco J, Bradbury Elizabeth, Gunther-Murphy Christina
Department of Quantitative Health Sciences, University of Massachusetts Medical School, USA.
J Healthc Qual. 2013 Jan-Feb;35(1):30-40. doi: 10.1111/j.1945-1474.2011.00164.x. Epub 2011 Sep 14.
The goal of this article is to provide a succinct scan of the literature as it relates to the current thinking and practice in large-scale improvement initiatives in healthcare.
We employed a scan of the literature using a modified Delphi technique. A standard review form was used. The scan was limited to large-scale spread efforts in hospitals and healthcare systems. Each of the main factors that emerged during the scan was linked to secondary factors and organized using a driver diagram.
Four primary drivers (factors) emerged during our scan that inform large-scale change initiatives in healthcare: Planning and Infrastructure; Individual, Group, Organizational, and System Factors; The Process of Change; and Performance Measures and Evaluation.
Our scan identified a tremendous amount of work being done around the world to improve healthcare. In general, our findings suggest these initiatives tend to be fragmented from an implementation standpoint. We identified primary and secondary drivers (factors) that can be used by those responsible for implementing large-scale improvement initiatives both at a strategy level and in their daily work. These drivers could serve as a "checklist" of ideas to consider in different testing and implementation situations.
本文的目的是简要梳理与医疗保健领域大规模改进举措的当前思路和实践相关的文献。
我们采用了一种经过改进的德尔菲技术对文献进行梳理。使用了标准的综述表格。梳理工作局限于医院和医疗保健系统中的大规模推广工作。梳理过程中出现的每个主要因素都与次要因素相关联，并使用驱动因素图进行组织。
在我们的梳理过程中出现了四个主要驱动因素，这些因素为医疗保健领域的大规模变革举措提供了依据：规划与基础设施；个人、群体、组织和系统因素；变革过程；以及绩效衡量与评估。
我们的梳理发现世界各地正在开展大量改善医疗保健的工作。总体而言，我们的研究结果表明，从实施角度来看，这些举措往往是零散的。我们确定了主要和次要驱动因素，负责实施大规模改进举措的人员在战略层面及其日常工作中都可以使用这些因素。这些驱动因素可作为在不同测试和实施情况下需要考虑的想法的“清单”。
