Amar Claudia, Pomey Marie-Pascale, SanMartin Claudia, De Coster Carolyn, Noseworthy Tom
Collaboration for Innovation and Improvement, Canadian Foundation for Healthcare Improvement, Ottawa, Canada.
Int J Health Care Qual Assur. 2015;28(4):320-31. doi: 10.1108/IJHCQA-11-2013-0131.
The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months.
DESIGN/METHODOLOGY/APPROACH: The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools.
Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit.
ORIGINALITY/VALUE: The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.
本文旨在研究加拿大的组织和系统因素，这些因素使得等待时间能够在联邦规定的限制内保持至少18个月。
设计/方法/途径：研究设计为多案例研究。本文选取了三个案例：案例1——工作人员能够在18个月以上的时间内保持符合要求；案例2——工作人员能够在18个月内达到要求，但无法维持这一水平；案例3——工作人员从未能够达到要求。对于每个案例，作者采访了参与策略制定的人员并收集了文件。本文分析了系统和组织层面的因素，包括治理与领导、文化、资源、方法和工具。
研究结果表明，能够保持符合等待时间要求的医院具有特定特征：仅进行髋关节和膝关节置换手术的专属任务；积极性高的工作人员，不受其他事务干扰；以及强烈的团队精神。
原创性/价值：作者的研究突出了三个案例在维持等待时间的因素方面的重要差异。本文表明，在超级专科手术背景下，医院工厂模式似乎具有吸引力。然而，接受手术的患者是被挑选出来进行简单手术且无并发症的，因此这不能被视为一种独特的模式。
