Harlos Karen, Tetroe Jacqueline, Graham Ian D, Bird Madeleine, Robinson Nicole
Department of Business and Administration, University of Winnipeg, Winnipeg, MB.
Healthc Policy. 2012 Aug;8(1):33-48.
We synthesized the management and health literatures for insights into implementing evidence-based change in healthcare drawn from industry-specific data. Because change principles based on evidence often fail to be translated into organizational practice or policy, we sought studies at the nexus of organizational change and knowledge translation.
We reviewed five top management journals to identify an initial pool of 3,091 studies, which yielded a final sample of 100 studies. Data were abstracted, verified by the original authors and revised before entry into a database. We employed a systematic narrative synthesis approach using words and text to distill data and explain relationships. We categorized studies by varying levels of relevance for knowledge translation as (1) primary, direct; (2) intermediate; and (3) secondary, indirect. We also identified recurring categories of change-related organizational factors. The current analysis examines these factors in studies of primary relevance to knowledge translation, which we also coded for intervention readiness to reflect how readily change can be implemented. Preliminary
Results centred on five change-related categories: Tailoring the Intervention Message; Institutional Links/Social Networks; Training; Quality of Work Relationships; and Fit to Organization. In particular, networks across institutional and individual levels appeared as prominent pathways for changing healthcare organizations. Power dynamics, positive social relations and team structures also played key roles in implementing change and translating it into practice. We analyzed journals in which first authors of these studies typically publish, and found evidence that management and health sciences remain divided. Bridging these disciplines through research syntheses promises a wealth of evidence and insights, well worth mining in the search for change that works in healthcare transformation.
我们综合了管理和健康领域的文献，以深入了解如何根据特定行业数据在医疗保健领域实施基于证据的变革。由于基于证据的变革原则往往未能转化为组织实践或政策，我们在组织变革与知识转化的交叉点上寻找相关研究。
我们查阅了五本顶级管理期刊，确定了3091项研究的初始样本，最终样本为100项研究。数据进行了提取，经原作者核实并在录入数据库前进行了修订。我们采用系统的叙述性综合方法，利用文字和文本提炼数据并解释关系。我们根据与知识转化的不同相关程度将研究分类为：（1）主要的、直接的；（2）中间的；（3）次要的、间接的。我们还确定了与变革相关的组织因素的反复出现的类别。当前的分析考察了与知识转化高度相关的研究中的这些因素，我们还对干预准备情况进行了编码，以反映变革实施的难易程度。
结果集中在五个与变革相关的类别上：调整干预信息；机构联系/社会网络；培训；工作关系质量；与组织的契合度。特别是，机构和个人层面的网络似乎是改变医疗保健组织的重要途径。权力动态、积极的社会关系和团队结构在实施变革并将其转化为实践方面也发挥了关键作用。我们分析了这些研究的第一作者通常发表论文的期刊，发现管理和健康科学仍然存在分歧的证据。通过研究综合来弥合这些学科有望产生大量的证据和见解，在寻求医疗保健转型中有效的变革方面非常值得挖掘。
