医院质量监测和改进注册感知负担：混合方法研究。
Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study.
机构信息
Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
Int J Health Policy Manag. 2022 Feb 1;11(2):183-196. doi: 10.34172/ijhpm.2020.96.
BACKGROUND
Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals' perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work.
METHODS
A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer.
RESULTS
On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals' joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality.
CONCLUSION
Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.
背景
质量指标用于监测和改善医疗服务质量。然而，质量指标的数量和有效性存在争议，可能会影响医生和护士的工作满意度。目前缺乏关于登记负担的性质和后果的实证数据。本研究旨在确定和探讨医疗机构中医疗保健专业人员对质量登记的感知负担，以及这种负担对其工作满意度的影响。
方法
这是一项混合方法观察性研究，包括参与式观察、荷兰两家学术医院和一家教学医院的调查和半结构化访谈。研究参与者来自重症监护病房（ICU）、血液科和其他参与老年患者和前列腺或胃肠道癌患者护理的科室的 371 名医疗保健专业人员。
结果
平均而言，医疗保健专业人员每天在质量登记上花费 52.3 分钟。每个科室的平均质量指标数量为 91 个，有 1380 个潜在变量。总体而言，57%的指标主要用于问责目的，19%用于机构治理，25%用于质量改进目标。只有 36%的人认为这些指标对改善日常实践中的质量有用。确定了八种类型的登记负担，例如登记数量过多、缺乏提高质量的实用性以及登记过程中的效率低下。医疗保健专业人员在质量登记上花费的时间与工作满意度的任何衡量标准均无相关性。感知到的不合理登记与医疗保健专业人员的工作满意度（内在动机和自主性）呈负相关。医疗保健专业人员认为质量登记会分散他们照顾患者和实际提高质量的时间。
结论
减少质量指标的数量，但增加对医疗保健专业人员真正重要的指标，是提高登记在质量改进和治理方面的有效性的关键。还应通过人员配备和信息通信技术解决方案提高质量登记的效率，以减少护士和医生的登记负担。
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