KTH Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden; Department of Sociology and Work Science, Gothenburg University, Gothenburg, Sweden.
KTH Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
Appl Ergon. 2018 Apr;68:249-257. doi: 10.1016/j.apergo.2017.12.001. Epub 2017 Dec 15.
The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.
瑞典的医疗保健系统正在重新定位为面向医疗流程的水平组织。主要挑战是让医疗保健临床医生参与这一过程。本研究旨在评估医疗保健临床医生的参与度（即态度和信念、认知状态和临床参与行为），并探讨在组织重新设计过程中，参与度与工作资源和工作需求之间的关系。采用队列研究方法，向五家采用医疗流程改进方法的医院的临床医生发放问卷，其中两家采用了精益生产。研究结果表明，各种参与度相互关联，有助于提高医疗质量和患者安全方面的临床参与行为。增加工作资源对组织改进中的参与度很重要，尤其是在自上而下的实施中。支持在医疗保健组织改进期间扩展工作参与模型。该模型有助于了解临床医生在何时以及如何被动员参与组织变革。
