Frawley Timmy, Meehan Annabel, De Brún Aoife
School of Nursing, Midwifery and Health Systems, University College Dublin College of Health Sciences , Dublin, Ireland.
Mental Health Division, St John of God Community Mental Health Services, Dublin, Ireland.
J Health Organ Manag. 2018 Nov 19;32(8):980-1001. doi: 10.1108/JHOM-08-2018-0220. Epub 2018 Nov 22.
The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.
DESIGN/METHODOLOGY/APPROACH: Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard's framework.
Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders' ability to focus on, and advance, the quality and safety agenda.
RESEARCH LIMITATIONS/IMPLICATIONS: Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.
There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.
ORIGINALITY/VALUE: The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.
本文旨在探讨组织和结构变革对卫生组织，特别是心理健康服务机构质量与安全演变的影响。
设计/方法/途径：通过半结构化访谈收集数据。总共对25名公共和私立心理健康服务机构的行政管理团队成员进行了访谈，并使用伯纳尔德的框架对数据进行了分析。
出现了三个总体主题：组织特征、领导力与问责制；与利益相关者保持协作与参与；质量与安全的挑战及促进因素。总体而言，研究结果表明持续的组织变革和重组对领导者关注和推进质量与安全议程的能力具有破坏性和迷惑性影响。
研究局限性/启示：这类定性研究的典型情况是，必须承认研究结果的普遍适用性可能有限。
需要有基于证据和理论，并借鉴数十年关于该主题研究的变革实施策略，而不是临时引入。变革推动者必须根据具体实施内容，将有效的变革管理和实施科学策略与特定背景相结合，并确保对组织变革进行适当评估，以加强围绕质量与安全的证据基础，并为未来决策提供信息。
原创性/价值：该研究探讨了现有文献中关于持续的组织重组和转型对心理健康服务质量与安全演变影响方面的一个明显空白。
