Department of Medicine, Baystate Medical Center, , Springfield, Massachusetts, USA.
BMJ Qual Saf. 2013 Oct;22(10):826-35. doi: 10.1136/bmjqs-2012-001683. Epub 2013 Jun 8.
To elicit sources of waste as viewed by hospital workers.
Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion.
U.S. academic tertiary care hospital.
Physicians, nurses, pharmacists, administrative support personnel, administrators and respiratory therapists.
A purposive sample of personnel at an academic tertiary care hospital was invited to take up to 10 photos of waste. Participants discussed their selections using photos as prompts during in-depth interviews. Transcripts were analysed in an iterative process using grounded theory; open and axial coding was performed, followed by selective and thematic coding to develop major themes and subthemes.
Twenty-one participants (nine women, average number of years in field=19.3) took 159 photos. Major themes included types of waste and recommendations to reduce waste. Types of waste comprised four major categories: Time, Materials, Energy and Talent. Participants emphasised time wastage (50% of photos) over other types of waste such as excess utilisation (2.5%). Energy and Talent were novel categories of waste. Recommendations to reduce waste included interventions at the micro-level (eg, individual/ward), meso-level (eg, institution) and macro-level (eg, payor/public policy).
The waste hospital workers identified differed from previously described waste both in the types of waste described and the emphasis placed on wasted time. The findings of this study represent a possible need for education of hospital workers about known types of waste, an opportunity to assess the impact of novel types of waste described and an opportunity to intervene to reduce the waste identified.
了解医院工作人员眼中的浪费来源。
使用照片诱发法进行定性研究，这是一种启发深入讨论的民族志技术。
美国学术性三级保健医院。
医生、护士、药剂师、行政支持人员、行政人员和呼吸治疗师。
邀请学术性三级保健医院的工作人员进行有针对性的抽样，让他们最多拍摄 10 张浪费的照片。参与者使用照片作为提示，在深入访谈中讨论他们的选择。使用扎根理论对转录本进行迭代分析；进行开放式和轴向编码，然后进行选择性和主题编码，以开发主要主题和子主题。
21 名参与者（9 名女性，平均在该领域的工作年限为 19.3 年）拍摄了 159 张照片。主要主题包括浪费的类型和减少浪费的建议。浪费类型包括四个主要类别：时间、材料、能源和人才。参与者强调浪费时间（占照片的 50%），而不是其他类型的浪费，如过度利用（占 2.5%）。能源和人才是浪费的新类别。减少浪费的建议包括在微观层面（例如，个人/病房）、中观层面（例如，机构）和宏观层面（例如，支付方/公共政策）进行干预。
医院工作人员所识别的浪费与之前描述的浪费类型不同，他们更强调浪费时间。本研究的结果表明，医院工作人员可能需要接受关于已知类型浪费的教育，有机会评估所描述的新型浪费的影响，并提供减少所确定的浪费的机会。
