Gabutti Irene, Mascia Daniele, Cicchetti Americo
Department of management, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
Department of Management, University of Bologna, Bologna, Italy.
BMC Health Serv Res. 2017 May 22;17(1):364. doi: 10.1186/s12913-017-2306-0.
The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff.
This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach.
Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects.
This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of "gaps" in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations' management on how to concretely and effectively implement new organizational models.
发达国家的医疗保健状况正在发生深刻变化：经常受到多种慢性疾病困扰的患者期望值有所提高。与此同时，存在巨大的财务压力，要求医疗机构用相同（或减少）的资源提供更多更好的服务。为应对这些挑战，医院正通过整合、重新设计和调动其组织及员工来进行彻底变革。
本研究的宏伟目标是阐明并清晰标注出发达经济体中医院正在加强的变革趋势，以便充分了解共同趋势的存在情况以及哪些组织模式和特征正在激励最具创新性的组织。目的是梳理医院组织领域中关于医院如何变革以及如何通过管理工具有效实施这种变革的已知情况。为此，所采用的方法将系统的文献综述与更广泛的参与式研究方法相结合。
有证据表明，该系统变革的三大支柱是渐进式患者护理模式、以患者为中心的方法和精益方法。然而，在如何利用变革驱动因素及其影响方面，仍存在一些认知空白。
本研究证实，文献中的努力主要集中在分析新模型和方法实施中的特定经验，因此未能在组织和组织间层面扩展分析，从而无法合理得出可推广的结论。在如何利用变革驱动因素及其影响方面似乎存在一些“空白”，这表明迄今为止所采用的研究方法未能为政策制定者和组织管理层提供关于如何具体有效地实施新组织模式的明确指导。
