Nardone D A, Webb D W
Oregon Sciences University, Portland.
Acad Med. 1989 Oct;64(10 Suppl):S28-34. doi: 10.1097/00001888-198910000-00023.
Deficiencies in management of U.S. Department of Veterans Affairs (USDVA) ambulatory care programs have been documented in the literature and were reaffirmed by conference participants. These represent significant barriers to developing an effective and efficient system of outpatient health care delivery for veterans and to expanding educational opportunities for trainees. Based on impact and feasibility rankings from the symposium, review of the literature, and the personal experiences of USDVA ambulatory care managers, several recommendations emerged: (1) implement a system of matrix management; (2) invest in a leader; (3) develop "user-friendly" management information systems; (4) utilize existing resources efficiently; (5) embrace quality assurance; and (6) improve support from clerical and diagnostic services, nursing, and pharmacy personnel. Although intervention from leadership at the level of the USDVA Central Office will be necessary, many of these recommendations can be adopted by managers at the local facilities. The biggest challenge is to change the attitudes of clinical and support staff whose responsibilities have traditionally been inpatient-oriented.
美国退伍军人事务部（USDVA）门诊护理项目管理方面的缺陷已在文献中有所记载，会议参与者也再次予以确认。这些缺陷对为退伍军人建立一个高效的门诊医疗服务体系以及为实习生扩大教育机会构成了重大障碍。基于研讨会的影响和可行性排名、文献综述以及USDVA门诊护理管理人员的个人经验，提出了以下几项建议：（1）实施矩阵管理系统；（2）投资培养一位领导者；（3）开发“用户友好型”管理信息系统；（4）有效利用现有资源；（5）采用质量保证措施；（6）加强文书、诊断服务、护理和药房人员的支持。尽管需要USDVA中央办公室层面的领导进行干预，但当地机构的管理人员可以采纳其中许多建议。最大的挑战是改变临床和支持人员的态度，他们传统上的职责一直以住院病人为导向。
