Author Affiliations: University of Michigan School of Nursing (Drs. Lafferty, Manojlovich, and Friese and Mr. Wright); Michigan Oncology Quality Consortium (Dr Griggs); Ann Arbor Veterans Administration Health System, Center for Clinical Management Research (Dr Harrod); and Division of Hematology/Oncology, Internal Medicine, University of Michigan (Dr Griggs), Ann Arbor.
Cancer Nurs. 2021;44(5):E303-E310. doi: 10.1097/NCC.0000000000000832.
Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery.
The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians.
Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings.
Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes.
These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery.
Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices' strengths and opportunities for improvement.
每天，流动肿瘤诊所都要为数千名使用高风险和高成本抗肿瘤药物的美国患者提供治疗。然而，我们对这些多样化的实践以及影响护理服务提供的组织结构知之甚少。
本研究旨在检查流动肿瘤诊所中临床医生报告的影响患者和临床医生护理服务提供过程和结果的因素。
2017 年，从密歇根州 29 个流动诊所的 298 名临床医生（护士、医生、执业护士和医师助理）收集了调查数据。临床医生对其工作环境中有利于和不利于提供高质量护理的方面提供了书面意见。我们进行了归纳内容分析，并使用患者安全系统工程倡议的工作系统模型来组织和解释我们的发现。
临床医生报告了患者安全系统工程倡议模型的所有 5 个工作系统组件中的影响护理服务提供和结果的因素。出现了一些共同的主题，例如不利方面包括人员配备不足和患者数量多、有限的物理空间、电子健康记录可用性问题以及医嘱输入。经常出现的有利方面主要集中在同事的技能、协作和团队合作上。一些临床医生明确报告了工作系统因素是如何相互影响以及影响患者、临床医生和组织结果的。
这些发现表明工作系统组件是相互作用和相互关联的，反映了护理服务提供的复杂性。
从一线临床医生那里获得的数据可以支持领导者进行组织变革，这些变革与临床医生对实践优势和改进机会的观察相一致。
