Dunham Annette H, Dunbar James A, Johnson Julie K, Fuller Jeff, Morgan Mark, Ford Dale
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Deakin Rural Health School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia.
BMJ Open. 2018 Apr 10;8(4):e020552. doi: 10.1136/bmjopen-2017-020552.
To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them.
Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems.
Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations.
Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses.
Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support.
Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision.
确定澳大利亚高效全科医疗服务机构的成功归因，以及它们认为希望效仿的机构在实现成功过程中的促进因素和障碍。
采用半结构化访谈和数据内容分析的定性研究。根据高效临床微观系统的成功特征，对回答进行记录、逐字转录并编码。
初级医疗保健领域，参与的全科医疗服务机构代表了澳大利亚所有州和领地，涵盖城市和农村地区。
通过多项成功标准确定的22家高效全科医疗服务机构。52名参与者包括19名全科医生、18名诊所经理和15名执业护士。
参与者最常将成功归因于团队成员的相互依存、以患者为中心的护理以及诊所的领导力。他们最常指出诊所领导力、团队相互依存和员工关注是其他机构为效仿其成功所需的促进因素。他们最常确定可能遇到的障碍，表现为诊所领导力、员工关注和中观系统支持方面的潜在不足或限制。
诊所领导者需要通过提供促进团队相互依存的包容性领导力，赋予团队采取行动的权力。中观系统对全科医疗服务质量改进的支持应侧重于促进这种领导力和团队建设，从而确保改进努力转化为有效的医疗服务提供。
