Department of Family Medicine, The Ohio State University, Columbus, USA.
Department of Health Systems Management, Rush University, National Center for Healthcare Leadership, Chicago, Illinois, USA.
J Healthc Manag. 2013 Nov-Dec;58(6):446-62; discussion 463-4.
Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation. We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.
跨行业研究表明，系统地采用高绩效工作实践（HPWPs）可能是改善医疗机构护理质量的有效但未充分利用的策略。HPWPs 的最佳使用取决于它们的实施方式，但我们对它们在医疗保健中的实施情况知之甚少。我们在五个医疗机构进行了 67 次关键知情人访谈，这些机构都被认为实施了出色的工作实践，并提供了高质量的护理，这是对医疗保健中 HPWP 使用情况进行广泛研究的一部分。我们对访谈记录进行了归纳和演绎分析，以研究组织实施 HPWPs 的原因和方式。我们使用基于证据的复杂创新采用模型来指导我们对促进 HPWP 实施的因素的探索。我们发现，受访者实施 HPWPs 的原因存在很大差异，包括宏观组织（战略层面）和微观组织（个人层面）的原因。这种差异突出了许多组织中 HPWP 实施的复杂背景。我们还发现，我们对创新实施模型的应用有助于澄清和分类 HPWP 实施的促进因素，从而深入了解这些因素如何有助于实施效果。明确定义、建立承诺以及确保工作实践应用的一致性，可能是成功实施的特别重要的要素。
