Robbins Julie, Garman Andrew N, Song Paula H, McAlearney Ann Scheck
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43202, USA.
Qual Manag Health Care. 2012 Jul-Sep;21(3):188-202. doi: 10.1097/QMH.0b013e31825e88f6.
As hospitals focus on increasing health care value, process improvement strategies have proliferated, seemingly faster than the evidence base supporting them. Yet, most process improvement strategies are associated with work practices for which solid evidence does exist. Evaluating improvement strategies in the context of evidence-based work practices can provide guidance about which strategies would work best for a given health care organization.
We combined a literature review with analysis of key informant interview data collected from 5 case studies of high-performance work practices (HPWPs) in health care organizations. We explored the link between an evidence-based framework for HPWP use and 3 process improvement strategies: Hardwiring Excellence, Lean/Six Sigma, and Baldrige.
We found that each of these process improvement strategies has not only strengths but also important gaps with respect to incorporating HPWPs involving engaging staff, aligning leaders, acquiring and developing talent, and empowering the front line. Given differences among these strategies, our analyses suggest that some may work better than others for individual health care organizations, depending on the organizations' current management systems. In practice, most organizations implementing improvement strategies would benefit from including evidence-based HPWPs to maximize the potential for process improvement strategies to increase value in health care.
随着医院致力于提高医疗保健价值，流程改进策略大量涌现，其发展速度似乎超过了支持这些策略的证据基础。然而，大多数流程改进策略都与确实存在确凿证据的工作实践相关。在循证工作实践的背景下评估改进策略，可以为确定哪些策略对特定的医疗保健组织最有效提供指导。
我们将文献综述与对从5个医疗保健组织的高绩效工作实践（HPWP）案例研究中收集的关键信息访谈数据的分析相结合。我们探讨了基于证据的HPWP使用框架与3种流程改进策略之间的联系：卓越固化、精益/六西格玛和波多里奇。
我们发现，这些流程改进策略中的每一种不仅有优势，而且在纳入涉及员工参与、领导者协调、人才获取与培养以及一线授权的HPWP方面都存在重要差距。鉴于这些策略之间的差异，我们的分析表明，对于个别医疗保健组织而言，根据其当前的管理系统，某些策略可能比其他策略更有效。在实践中，大多数实施改进策略的组织将受益于纳入基于证据的HPWP，以最大限度地发挥流程改进策略在提高医疗保健价值方面的潜力。
