Schriver Michael, Cubaka Vincent Kalumire, Itangishaka Sylvere, Nyirazinyoye Laetitia, Kallestrup Per
Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
Aarhus University Hospital, Aarhus, Denmark.
PLoS One. 2018 Feb 20;13(2):e0189844. doi: 10.1371/journal.pone.0189844. eCollection 2018.
External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear.
To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision.
Qualitative, exploratory study.
Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers.
Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed.
While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.
在低收入和中等收入国家，对基层医疗设施的外部监督通常主要出于管理目的，其中对专业发展的支持作用尚不明确。
探讨卢旺达基层医疗监督人员和提供者（被监督者）如何看待外部监督的评估和形成性职能。
定性探索性研究。
焦点小组讨论：与监督人员进行了3次讨论，与提供者进行了3次讨论，1次混合讨论（n = 31）。研究结果与个别监督人员和提供者群体进行了讨论。
评估活动占据了提供者对监督的理解，包括检查、纠正、评分和基于绩效的融资。这些被视为激励的来源，在自我决定理论中表明是内摄调节。监督人员更愿意强调他们在形成性监督中的作用，这可能掩盖了他们自己和提供者无可争议的说法，即系统的绩效评估在监督人员的工作中占主导地位。提供者强烈要求更多地关注形成性和支持性职能，大多数监督人员也表达了这一点。讨论了绩效评估对动机和专业发展的影响。
虽然外部监督人员旨在支持提供者的专业发展，但我们的研究结果表明，在频繁评估和绩效评分的背景下，这存在严重问题。将支持者和评估者 的角色分开似乎不是简单的解决方案。如果外部监督要改善医疗服务，至关重要的是监督人员和健康中心管理人员有能力以透明地说明各种绩效压力的方式支持提供者。这包括提供适当的形成性监督并给予有用的反馈，维持有效的监督关系，以及确保提供者了解评估和形成性监督职能的目的和内容。
Zotero 插件