Brooks Joanna Veazey, Gorbenko Ksenia, Bosk Charles
Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City (Dr Brooks); Department of Population Health Science and Policy, Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York (Dr Gorbenko); and Department of Sociology, Department of Anesthesia and Critical Care, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Dr Bosk).
Qual Manag Health Care. 2017 Apr/Jun;26(2):55-62. doi: 10.1097/QMH.0000000000000128.
Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project.
Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis.
We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project.
Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work.
Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.
在医院实施质量改进需要领导者在财务、物资和人力资源等多方面做出承诺。然而，对于项目实施所需的互动资源却知之甚少。本分析的目的是确定医院团队在外科质量改进项目中寻求的互动支持类型。
通过观察、访谈和焦点小组相结合的方式对医院进行实地考察，以探讨外科质量改进项目的实施情况。2012年10月至2014年8月期间，对总共16家同意参与的医院进行了26次实地考察。所有访谈均进行了录音、转录，并采用归纳分析对主题进行编码。
我们采访了321名受访者，并另外开展了28个焦点小组。受访者表示，在实施质量改进干预措施期间需要以下类型的互动支持：（1）对其实施进展的批判性外部视角；（2）向同行学习的机会，尤其是围绕临床创新方面；（3）外部认可，以帮助提高项目的知名度并促使各方对项目做出承诺。
医院的质量改进既是一项临床工作，也是一项社会活动。我们的研究结果表明，团队在实施质量改进举措时通常需要互动资源。实地考察可以提供这些资源，同时还能激发团队的情感能量，为质量改进工作营造动力和可持续性。
政策制定者和质量改进领导者将受益于制定策略，以最大限度地促进质量改进团队的互动学习和反馈。进一步的研究应调查满足这些需求的最有效方法。
