Hernández Alison R, Hurtig Anna-Karin, Dahlblom Kjerstin, San Sebastián Miguel
Division of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
Int J Equity Health. 2015 Oct 8;14:91. doi: 10.1186/s12939-015-0225-4.
Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance.
A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers.
The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors.
This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who require support, including managers and community-level collaborators. Organizational climate is critical for making auxiliary nurses feel supported, and greater attention to improving the quality of hierarchical relationships is needed in LMIC settings. The participatory nature of the concept-mapping process enabled health system actors to collaborate in co-production of context-specific knowledge needed to guide efforts to strengthen performance in a vulnerable region.
在许多低收入和中等收入国家的医疗服务欠缺地区，中级卫生工作者处于一线，他们的工作表现对于改善弱势群体的健康状况至关重要。然而，在资源匮乏的环境中提高工作表现是复杂的，并且高度依赖于当地卫生系统的组织环境。本研究旨在调查危地马拉一个地区卫生系统中不同层级的行为主体对于支持辅助护士工作表现的行动的看法，辅助护士是中级卫生工作者中的一个群体，在公共部门服务提供中发挥着重要作用。开展了一项概念映射研究，以形成关于组织支持的综合观点，并确定加强工作表现的当地相关策略。
共有93名地区和区级管理人员以及基层和二级医疗保健工作者参与了关于支持辅助护士工作表现所需行动的想法生成。想法被整合为30个行动项目，通过排序和评级练习进行结构化，共有135名管理人员和医疗工作者参与。使用一系列多元统计分析生成了描绘参与者对行动领域和子群体利益动态的综合观点的地图，并由地区管理人员进行解读。
卫生系统行为主体的综合意见提供了支持工作表现所需行动的多方面观点，这些行动被组织在六个领域中，包括：沟通与协调、工作导向工具、支持性组织氛围、认可激励、专业发展和技能发展。不同层级之间关系的性质被确定为一个贯穿各领域的主题。模式匹配和行动区域图根据行为主体子群体之间的共识和差异领域指明了行动方向。
本研究表明，辅助护士的工作表现与其他需要支持的卫生系统行为主体（包括管理人员和社区层面的合作者）的表现相互关联。组织氛围对于让辅助护士感到得到支持至关重要，在低收入和中等收入国家的环境中，需要更加关注改善层级关系的质量。概念映射过程的参与性质使卫生系统行为主体能够合作共同生成指导在一个弱势群体地区加强工作表现努力所需的特定背景知识。
