Hastings Stephanie E, Armitage Gail D, Mallinson Sara, Jackson Karen, Suter Esther
Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada.
BMC Health Serv Res. 2014 Oct 4;14:479. doi: 10.1186/1472-6963-14-479.
The objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes. Particular attention was paid to how governance mechanisms facilitate change in the workforce to ensure the effective use of all health providers.
In accordance with standard systematic review procedures, the research team independently screened over 4300 abstracts found in database searches, website searches, and bibliographies. Searches were limited to 2001-2012, included only publications from Canada, the United Kingdom, the Netherlands, New Zealand, Australia, and the United States. Peer- reviewed papers and grey literature were considered. Two reviewers independently rated articles on quality and relevance and classified them into themes identified by the team. One hundred and thirteen articles that discussed both workforce and governance were retained and extracted into narrative summary tables for synthesis.
Six types of governance mechanisms emerged from our analysis. Shared governance, Magnet accreditation, and professional development initiatives were all associated with improved outcomes for the health workforce (e.g., decreased turnover, increased job satisfaction, increased empowerment, etc.). Implementation of quality-focused initiatives was associated with apprehension among providers, but opportunities for provider training on these initiatives increased quality and improved work attitudes. Research on reorganization of healthcare delivery suggests that changing to team-based care is accompanied by stress and concerns about role clarity, that outcomes vary for providers in private versus public organizations, and that co-operative clinics are beneficial for physicians. Funding schemes required a supplementary search to achieve adequate depth and coverage. Those findings are reported elsewhere.
The results of the review show that while there are governance mechanisms that consider workforce impacts, it is not to the extent one might expect given the importance of the workforce for improving patient outcomes. Furthermore, to successfully implement governance mechanisms in this domain, there are key strategies recommended to support change and achieve desired outcomes. The most important of these are: to build trust by clearly articulating the organization's goal; considering the workforce through planning, implementation, and evaluation phases; and providing strong leadership.
本系统综述旨在综合各类证据，探讨卫生系统治理与劳动力成果之间的关系。特别关注治理机制如何推动劳动力方面的变革，以确保所有卫生服务提供者得到有效利用。
按照标准的系统综述程序，研究团队独立筛选了在数据库搜索、网站搜索及参考文献中找到的4300多篇摘要。搜索范围限定在2001年至2012年，仅包括来自加拿大、英国、荷兰、新西兰、澳大利亚和美国的出版物。纳入了同行评审论文和灰色文献。两名评审员独立对文章的质量和相关性进行评分，并将其归类为团队确定的主题。保留了113篇既讨论了劳动力又讨论了治理的文章，并提取到叙述性总结表中进行综合分析。
我们的分析得出了六种治理机制。共享治理、磁体认证和专业发展举措均与卫生人力的改善成果相关（如离职率降低、工作满意度提高、赋权增加等）。以质量为重点的举措的实施与提供者的担忧相关，但针对这些举措的提供者培训机会提高了质量并改善了工作态度。关于医疗服务提供重组的研究表明，转向团队式护理伴随着压力以及对角色清晰度的担忧，私立与公立组织中提供者的结果有所不同，合作诊所对医生有益。资金计划需要额外搜索以获得足够的深度和覆盖范围。这些结果在其他地方报告。
综述结果表明，虽然存在考虑劳动力影响的治理机制，但鉴于劳动力对改善患者结果的重要性，其程度并未达到预期。此外，要在该领域成功实施治理机制，建议采用关键策略来支持变革并实现预期结果。其中最重要的是：通过清晰阐述组织目标来建立信任；在规划、实施和评估阶段考虑劳动力；以及提供强有力的领导。
