Nyström Monica Elisabeth, Garvare Rickard, Westerlund Anna, Weinehall Lars
Karolinska Institutet, Medical Management Centre, Stockholm, Sweden.
Int J Health Care Qual Assur. 2014;27(3):190-208. doi: 10.1108/IJHCQA-08-2012-0085.
Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.
DESIGN/METHODOLOGY/APPROACH: Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.
Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.
ORIGINALITY/VALUE: This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.
相互竞争的活动和项目可能会干扰新知识和新方法的实施。因此，本研究旨在调查瑞典一家医院同时实施两项质量改进计划的过程及影响。这两项计划分别是一项由地区发起的全系统组织学习项目，称为动态与活力组织（DVO），以及一项全国性的预防医疗相关感染和医院获得性感染（SHAI）倡议。这两项工作都致力于提高员工在系统改进方法方面的能力。
设计/方法/途径：采用了多种方法，包括调查、观察、访谈、过程日记、文件和组织测量。受访者包括科室经理、变革促进者和改进团队成员。
尽管两项计划采用了相同的改进方法，但没有有力证据表明它们在战略上相互结合以实现互利。这两项计划并存，有一定的协调，但也存在一些冲突。尽管缺乏利用全国性SHAI倡议的管理策略，但据报告在质量改进文化和沟通方面仍取得了积极进展。本研究表明，即使在有利的情况下，协调变革计划也存在内在困难。
原创性/价值：本文探讨了组织中同时存在且相互竞争的项目这种较少被研究但较为常见的情况。
