Bismark Marie M, Studdert David M
Melbourne School of Population and Global Health, Melbourne, Victoria, Australia.
Melbourne School of Population and Global Health & Melbourne Law School, Melbourne, Victoria, Australia.
BMJ Qual Saf. 2014 Jun;23(6):474-82. doi: 10.1136/bmjqs-2013-002193. Epub 2013 Dec 10.
To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards' activities in this area.
We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees' perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts.
Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations.
Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed.
描述卫生服务委员会在护理质量问题上的参与情况，并确定影响委员会在该领域活动的因素。
我们对澳大利亚维多利亚州13家公共卫生服务机构的35名董事会成员和管理人员进行了半结构化访谈。访谈重点关注董事会目前在监督护理质量方面所发挥的作用。我们还了解了受访者对影响他们目前在该领域治理方式的因素的看法。采用主题分析法从访谈记录中确定关键主题。
几乎所有受访者都认为，董事会有大量机会影响服务提供的护理质量，主要是通过确定优先事项、监测进展情况、追究工作人员责任和塑造文化。利用这种影响力的感知障碍包括资源不足、董事会成员技能和经验的差距、关于绩效的信息不足以及不符合要求的监管规定。受访者一致认为有四个因素有助于实现更有效的质量治理：加强区域合作；针对质量问题开展更具针对性的董事会培训；更明智地利用报告和认证要求；更好地获取可靠的、纵向的且能与同行组织进行基准对比的数据。
尽管卫生服务委员会渴望将护理质量作为治理重点，但仍有几个障碍阻碍着进展。结果是质量治理的言辞与董事会层面日常活动的现实之间存在差距。在解决这些障碍之前，无法实现董事会在该领域有效参与的迫切需求。
