Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Med Care. 2013 Jan;51(1):90-8. doi: 10.1097/MLR.0b013e31827632ec.
Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown.
To explore aspects of organizational culture to develop a deeper understanding of the discharge process.
A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data.
In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses.
Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices.
On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
组织文化被认为对医疗保健的质量和安全产生越来越大的影响，但它对医院到社区患者出院的影响相对未知。
探索组织文化的各个方面，以更深入地了解出院过程。
对出院过程中的利益相关者进行定性研究。采用扎根理论对数据进行分析。
在 5 个欧盟国家，对患者和亲属、医院医生、医院护士、全科医生和社区护士进行了 192 次个人访谈和 25 次焦点小组访谈。
出现了三个主题，代表了组织文化的各个方面：医院与初级保健之间支离破碎的接口、在出院过程中低估行政任务相对于临床任务的重要性、以及对出院过程或流程改进缺乏反思。确定了九个类别：医院护理提供者的内向焦点、对专业对应者的需求、技能和工作模式缺乏认识、缺乏协作态度、医院与初级保健提供者之间的关系、在“此时此地”提供护理、行政工作被认为是繁琐的、对反馈的消极态度、出院时的交接受习惯支配以及对新实践的欣赏和整合。
根据数据，我们假设医院护理提供者重视交接和与社区护理提供者联系的程度对有效的医院出院至关重要。社区护理提供者通常对患者的结果了解不足。与患者出院相关的持续挑战往往未被提及，错失了改进的机会。需要采取干预措施，将组织文化作为改善出院工作的关键因素。
