基于卡什模型九个步骤对伊朗克尔曼教学医院临床治理实施成功率的评估
Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model.
作者信息
Vali Leila, Mastaneh Zahra, Mouseli Ali, Kardanmoghadam Vida, Kamali Sodabeh
机构信息
Ph.D. of Health Services Management, Assistant Professor, Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Ph.D of Health Information Management, Assistant Professor, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
出版信息
Electron Physician. 2017 Jul 25;9(7):4841-4846. doi: 10.19082/4841. eCollection 2017 Jul.
BACKGROUND
One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services.
OBJECTIVE
To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model.
METHODS
This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16.
RESULTS
About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03).
CONCLUSION
Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.
背景
改善卫生系统服务质量的方法之一是通过临床治理。该方法旨在为临床服务提供者创建一个框架，使其为持续提高质量和维持服务标准负责。
目的
基于卡什模型的9个步骤评估克尔曼教学医院临床治理实施的成功率。
方法
2015年对94人进行了这项横断面研究，这些人包括首席执行官、护理经理、临床治理经理和专家、护士长和护士。所需数据通过研究者编制的包含38个问题的问卷收集，采用三点李克特量表（好、中等、差）。卡什模型包括九个步骤，即高层管理对变革的承诺、对变革的问责、创建变革的结构化方法、培训、试点实施、沟通、反馈、模拟和最终用户参与。使用描述性统计和曼-惠特尼-威尔科克森检验进行数据分析，由SPSS 16版软件完成。
结果
约81.9%的受访者为女性，74.5%拥有护理学学士学位。总体而言，基于该模型的9个步骤，研究医院临床治理实施的状况为44%（中等）。在问责与组织职位（p = 0.0012）以及研究领域（p = 0.000）之间观察到显著关系。此外，基于结构的方法与组织职位（p = 0.007）、沟通与人口统计学特征（p = 0.000）以及最终用户参与与组织职位（p = 0.03）之间存在显著关系。
结论
临床治理应通过正确的需求评估和所有利益相关者的参与来实施，以确保其在实践中的执行，并提高服务质量。
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