Thörne Karin, Andersson-Gäre Boel, Hult Håkan, Abrandt-Dahlgren Madeleine
Futurum, Academy for Health and Care, Region Jönköping County, Department of Medical and Health Sciences, Medical Faculty, Linköping University and The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Dr Thörne); The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Dr Andersson-Gäre); Department of Clinical Sciences Intervention and Technology Karolinska Institutet, Stockholm, Sweden (Dr Hult); and Department of Medical and Health Sciences, Medical Faculty, Linköping University, Linköping, Sweden (Dr Abrandt-Dahlgren).
Qual Manag Health Care. 2017 Apr/Jun;26(2):70-82. doi: 10.1097/QMH.0000000000000133.
Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients' active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on "clinical microsystems," where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine how changes in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their "double participation" (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.
在广泛的质量改进议程中，患者参与医疗保健已被广泛认为至关重要。包括患者积极参与的查房作为让患者参与、确保安全和提高质量的一种方式正在不断增加。一种新兴的研究质量改进的方法是关注“临床微系统”，即患者、专业人员和信息系统相互作用的地方。这为更深入地研究查房提供了机会。我们使用实践架构理论作为分析工具，研究了一种通过质量改进工作实施的新的查房模式。实践架构关注塑造人们工作行为的文化话语、社会政治和物质经济条件。实践架构是一种社会物质理论视角，有可能改变我们对实践、学习和变革之间关系的理解。在本研究中，我们考察了实践中的变化是如何实现的。结果表明，实践架构形成了共同生产性学习查房，这是一种将质量改进整合到日常工作中的可能模式。这出现在患者通过其“双重参与”（作为人以及作为屏幕上的信息）与病房查房室中的专业人员群体之间的相互作用中。然而，为了实现所有查房的目标，必须重新协商社会互动。
