Kreindler Sara A
Manitoba Research Chair in Health System Innovation, George and Fay Yee Centre for Healthcare Innovation, and Assistant Professor, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Health Plann Manage. 2018 Jan;33(1):e333-e343. doi: 10.1002/hpm.2481. Epub 2017 Dec 28.
Most health care organizations engage in formal and informal planning, yet their improvement initiatives may remain disjointed and reactive. Research on organizational decision-making has found that the "discovery" approach (seek and assess multiple options before selecting one) outperforms "idea imposition" (identify 1 option, then gather information to [dis]confirm it), yet is observed relatively infrequently. Might this imply that discovery frequently collapses before fruition? This qualitative study sought to better understand the planning-action disjunction, as observed in 1 organization, by comparing its planning processes against the discovery approach. It focused on a Canadian regional health system's recurrent, unsuccessful attempts to improve patient flow. Through extensive document review supplemented by interviews with 62 managers, it identified all relevant regional plans/reports produced during a 15-year period and followed each recommendation forward in time to discover its fate. Each report presented a lengthy, unprioritized list of disparate recommendations, few of which progressed to full implementation. It appeared that decision-makers repeatedly embarked on a discovery approach, but rapidly allowed it to splinter into multiple idea-imposition approaches; numerous options were generated, but never evaluated against each other. Thus, the product of each planning process was not a coherent strategy but a list of disconnected actions.
大多数医疗保健机构都会进行正式和非正式的规划，但其改进举措可能仍会脱节且缺乏前瞻性。对组织决策的研究发现，“探索”方法（在选择一个选项之前寻求并评估多个选项）优于“想法强加”方法（确定一个选项，然后收集信息来[反]证实它），然而这种方法相对较少被采用。这是否意味着探索往往在取得成果之前就失败了呢？这项定性研究试图通过将一个组织的规划过程与探索方法进行比较，来更好地理解规划与行动之间的脱节现象，该研究聚焦于加拿大一个地区卫生系统反复进行的、但未成功的改善患者流程的尝试。通过广泛的文档审查，并辅以对62名管理人员的访谈，研究确定了该地区在15年期间制定的所有相关计划/报告，并及时跟踪每项建议，以了解其最终结果。每份报告都列出了一长串未经优先排序的不同建议，其中很少有建议得到全面实施。似乎决策者们反复采用探索方法，但很快就让它分裂成多种想法强加方法；产生了众多选项，但从未相互评估。因此，每个规划过程的结果不是一个连贯的战略，而是一系列不相关的行动。
