Wiegmann Douglas A
Department of Industrial and Systems Engineering, Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison, WI.
Ann Surg. 2016 Jan;263(1):9-11. doi: 10.1097/SLA.0000000000001333.
Efforts to implement quality improvements in surgery are notoriously problematic. One needs to look no farther than recent attempts to implement checklists, team training, and surgical briefings. These interventions have been empirically shown to improve team communication and performance. Yet numerous barriers to implementation have limited their broad adoption and use. Apparently, knowing the remedy (intervention) does not translate into knowing how to administer (implement) it. Or in surgical terms, knowing "what" procedure needs to be performed does not necessarily mean that one knows "how" to perform it. Surgeons serve a vital leadership role in driving quality and patient safety initiatives in the operating room. Achieving success requires both an in-depth understanding of the intervention and the complex dynamics of the elements involved in the implementation process. To aid in this endeavor, the present article describes a Model for Understanding System Transitions Associated with the Implementation of New Goals (MUSTAING). The model highlights important variables associated with implementation success. It also provides a tool for diagnosing why certain interventions may not have worked as intended so that improvements in the implementation process can be made. Finally, the model offers a general framework for guiding future implementation or "how to" research.
在外科手术中实施质量改进的努力一直存在诸多问题。人们只需看看最近实施手术清单、团队培训和术前简报的尝试就知道了。这些干预措施已通过实证表明能改善团队沟通和绩效。然而，实施过程中存在的众多障碍限制了它们的广泛采用和应用。显然，知道补救措施（干预措施）并不意味着知道如何实施它。或者用外科术语来说，知道需要执行“什么”程序并不一定意味着知道“如何”执行它。外科医生在推动手术室的质量和患者安全举措方面发挥着至关重要的领导作用。要取得成功，既需要深入了解干预措施，也需要深入了解实施过程中涉及的各种因素的复杂动态。为了帮助实现这一目标，本文描述了一种与新目标实施相关的系统转变理解模型（MUSTAING）。该模型突出了与实施成功相关的重要变量。它还提供了一种工具，用于诊断某些干预措施为何可能未按预期发挥作用，以便改进实施过程。最后，该模型提供了一个总体框架，用于指导未来的实施或“如何做”研究。
