Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Fam Pract. 2013 Apr;30(2):204-11. doi: 10.1093/fampra/cms056. Epub 2012 Sep 17.
Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators.
The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP.
An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis.
Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability.
The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.
提高医疗保健质量的方法认识到需要建立有利于提供最佳护理的系统和文化。人际关系和动态是将系统转变为能够实现质量的系统的关键因素。家庭实践质量（QIFP）计划涵盖了使用家庭实践指标综合工具进行临床和实践管理。
本研究的目的是探讨和描述参与 QIFP 的两个附属学术初级保健诊所（包括一个家庭健康团队，FHT）的员工对临床实践环境变化的看法。
加拿大汉密尔顿的一个 FHT 在 2008/2009 年使用了质量工具。采用定性探索性案例研究方法来检查员工对参与过程的看法。在 2010 年初对 43 名 FHT 员工进行了半结构化访谈，其中包括医生、护士、联合健康专业人员、支持人员和管理人员。访谈进行了录音并逐字记录。采用修改后的模板方法进行编码，并采用复杂性理论视角进行分析。
主题包括领导力的重要性、实践环境的变化、沟通方式的变化、对团队角色和关系的理解的提高、团队合作的加强、通过赋权实现层次扁平化、临床护理和临床影响的变化、挑战和奖励以及可持续性。
该计划导致了关系、团队合作和士气的感知变化。解决领导力、角色清晰度、赋权、层次扁平化和团队合作等问题，可以为建立和维持质量文化奠定基础。
