Department of Veterans Affairs, Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, MA 02130, USA.
Med Care. 2013 Jan;51(1):108-14. doi: 10.1097/MLR.0b013e318277f1cb.
Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings.
基层医疗服务提供者面临着越来越大的压力，需要用更少的资源做更多的事情。我们通过对退伍军人健康管理局（Veterans Health Administration）222 个基层医疗诊所样本中的大约 44000 份患者体验调查，考察了工作量对患者医疗质量体验的影响。我们检验了团队合作的衡量指标——关系氛围在多大程度上调节了工作量和患者对医疗质量评价之间的关系。我们的结果衡量指标包括患者投诉、与提供者相处的时间和整体就诊质量。工作量与患者的医疗质量评价呈负相关，而关系氛围则调节了工作量和医疗质量评价之间的关系。与工作量较高但关系氛围较差的诊所相比，在工作量较高但关系氛围较好的诊所就诊的患者报告的护理质量更好。研究结果强调了关系氛围作为一种重要的团队合作因素的重要性，在资源有限的情况下，管理和制定诊所政策、实践和程序时都需要考虑这一因素。
