Alingh Carien W, van Wijngaarden Jeroen D H, Huijsman Robbert, Paauwe Jaap
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
Department of Human Resource Studies, Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands.
BMC Health Serv Res. 2018 May 2;18(1):313. doi: 10.1186/s12913-018-3116-8.
Hospitals are confronted with increasing safety demands from a diverse set of stakeholders, including governmental organisations, professional associations, health insurance companies, patient associations and the media. However, little is known about the effects of these institutional and competitive pressures on hospital safety management. Previous research has shown that organisations generally shape their safety management approach along the lines of control- or commitment-based management. Using a heuristic framework, based on the contextually-based human resource theory, we analysed how environmental pressures affect the safety management approach used by hospitals.
A qualitative study was conducted into hospital care in the Netherlands. Five hospitals were selected for participation, based on organisational characteristics as well as variation in their reputation for patient safety. We interviewed hospital managers and staff with a central role in safety management. A total of 43 semi-structured interviews were conducted with 48 respondents. The heuristic framework was used as an initial model for analysing the data, though new codes emerged from the data as well.
In order to ensure safe care delivery, institutional and competitive stakeholders often impose detailed safety requirements, strong forces for compliance and growing demands for accountability. As a consequence, hospitals experience a decrease in the room to manoeuvre. Hence, organisations increasingly choose a control-based management approach to make sure that safety demands are met. In contrast, in case of more abstract safety demands and an organisational culture which favours patient safety, hospitals generally experience more leeway. This often results in a stronger focus on commitment-based management.
Institutional and competitive conditions as well as strategic choices that hospitals make have resulted in various combinations of control- and commitment-based safety management. A balanced approach is required. A strong focus on control-based management generates extrinsic motivation in employees but may, at the same time, undermine or even diminish intrinsic motivation to work on patient safety. Emphasising commitment-based management may, in contrast, strengthen intrinsic motivation but increases the risk of priorities being set elsewhere. Currently, external pressures frequently lead to the adoption of control-based management. A balanced approach requires a shift towards more trust-based safety demands.
医院面临着来自包括政府组织、专业协会、健康保险公司、患者协会和媒体在内的各种利益相关者日益增加的安全要求。然而，对于这些机构和竞争压力对医院安全管理的影响却知之甚少。先前的研究表明，组织通常会按照基于控制或基于承诺的管理方式来塑造其安全管理方法。我们使用基于情境的人力资源理论的启发式框架，分析了环境压力如何影响医院所采用的安全管理方法。
对荷兰的医院护理进行了一项定性研究。根据组织特征以及它们在患者安全方面的声誉差异，选择了五家医院参与研究。我们采访了在安全管理中起核心作用的医院管理人员和工作人员。共对48名受访者进行了43次半结构化访谈。启发式框架被用作分析数据的初始模型，不过数据中也出现了新的编码。
为了确保提供安全的护理，机构和竞争利益相关者经常强加详细的安全要求、强大的合规压力以及对问责制不断增加的要求。结果，医院的回旋余地减少。因此，组织越来越多地选择基于控制的管理方法以确保满足安全要求。相比之下，在安全要求较为抽象且组织文化有利于患者安全的情况下，医院通常有更多的回旋余地。这通常会导致更加强调基于承诺的管理。
机构和竞争条件以及医院做出的战略选择导致了基于控制和基于承诺的安全管理的各种组合。需要一种平衡的方法。过于强调基于控制的管理会在员工中产生外在动机，但同时可能会削弱甚至减少致力于患者安全的内在动机。相比之下，强调基于承诺的管理可能会增强内在动机，但会增加在其他地方设定优先事项的风险。目前，外部压力经常导致采用基于控制的管理。一种平衡的方法需要转向更多基于信任的安全要求。
