Trebble Timothy M, Paul Maureen, Hockey Peter M, Heyworth Nicola, Humphrey Rachael, Powell Timothy, Clarke Nicholas
Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.
Department of Human Resources, School of Management, University of Southampton, Southampton, UK.
BMJ Qual Saf. 2015 Mar;24(3):212-20. doi: 10.1136/bmjqs-2014-003219. Epub 2015 Jan 27.
Improving the quality and activity of clinicians' practice improves patient care. Performance-related human resource management (HRM) is an established approach to improving individual practice but with limited use among clinicians. A framework for performance-related HRM was developed from successful practice in non-healthcare organisations centred on distributive leadership and locally provided, validated and interpreted performance measurement. This study evaluated the response of medical and non-clinical managers to its implementation into a large secondary healthcare organisation.
A semistructured qualitative questionnaire was developed from themes identified during framework implementation and included attitudes to previous approaches to measuring doctors' performance, and the structure and response to implementation of the performance-related HRM framework. Responses were analysed through a process of data summarising and categorising.
A total of 29, from an invited cohort of 31, medical and non-clinical managers from departmental to executive level were interviewed. Three themes were identified: (1) previous systems of managing clinical performance were considered to be ineffective due to insufficient empowerment of medical managers and poor quality of available performance data; (2) the implemented framework was considered to address these needs and was positively received by medical and non-clinical managers; (3) introduction of performance-related HRM required the involvement of the whole organisation to executive level and inclusion within organisational strategy, structure and training.
This study suggests that a performance-related HRM framework may facilitate the management of clinical performance in secondary healthcare, but is dependent on the design and methods of application used. Such approaches contrast with those currently proposed for clinicians in secondary healthcare in the UK and suggest that alternative strategies should be considered.
提高临床医生的执业质量和积极性可改善患者护理。与绩效相关的人力资源管理（HRM）是一种既定的提高个人执业水平的方法，但在临床医生中应用有限。一个与绩效相关的HRM框架是从非医疗组织的成功实践中发展而来的，该框架以分布式领导以及本地提供、验证和解释的绩效评估为核心。本研究评估了医疗和非临床管理人员对其在一家大型二级医疗保健机构实施情况的反应。
根据框架实施过程中确定的主题制定了一份半结构化定性问卷，内容包括对以往医生绩效评估方法的态度，以及对与绩效相关的HRM框架实施的结构和反应。通过数据汇总和分类过程对回复进行分析。
在受邀的31名医疗和非临床管理人员（从部门级到行政级）中，共采访了29人。确定了三个主题：（1）由于医疗管理人员的权力不足以及可用绩效数据质量差，以前管理临床绩效的系统被认为无效；（2）实施的框架被认为满足了这些需求，并得到了医疗和非临床管理人员的积极认可；（3）引入与绩效相关的HRM需要整个组织从部门级到行政级的参与，并纳入组织战略、结构和培训之中。
本研究表明，与绩效相关的HRM框架可能有助于二级医疗保健机构中临床绩效的管理，但这取决于所采用的设计和应用方法。这些方法与英国目前针对二级医疗保健机构临床医生提出的方法不同，表明应考虑其他替代策略。
