School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052, Australia.
School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia.
BMC Health Serv Res. 2020 Oct 15;20(1):952. doi: 10.1186/s12913-020-05812-3.
Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.
A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.
Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools.
Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.
国际医疗保健服务正将护理重点转移到以患者为中心、整合的护理上，利用有效、高效和创新的护理模式来优化患者的结果和系统的可持续性。尽管已经做出了巨大的努力来检查和提高患者体验，但迄今为止，在提供者体验方面几乎没有取得进展。本综述旨在通过捕捉临床医生经验的证据，以及在医疗系统变革和创新背景下如何定义和衡量这种经验，来探索这一知识空白。
利用快速证据评估方法对已发表文献和灰色文献进行了快速审查。从文献中检索到的 79 项研究被纳入了综述。从灰色文献检索中确定了 14 篇文章，并通过手工检索获得了 1 篇文章。总共 94 篇文章被纳入综述。这项研究是由新南威尔士州卫生部委托和共同设计的。
文献中对提供医疗保健的临床医生经验的定义不一致，确定的文章缺乏对经验、参与度和与工作相关的结果（如工作满意度）之间区别的明确性。临床医生经验通常使用关注正在发生变化的离散医疗保健活动或事件的经验的定性研究来探索。此类研究使复杂的经验得以探索。在这些情况下，临床医生的经验是通过临床医生提供的有关医疗保健活动或事件的自我报告信息、他们对其价值的看法、他们所经历的实际影响以及他们在活动或事件方面表现出的具体行为来捕获的。此外，临床医生的经验缺乏衡量工具。
迄今为止，文献并未从整体意义上研究临床医生的经验。为了实现与基于价值的护理相关的目标，需要进一步努力来概念化临床医生的经验，并了解评估这一经验所需的衡量工具的性质。在医疗系统应用中，更广泛的“临床医生脉搏”式评估可能有助于了解临床工作的连续性体验，而不是在变化/护理事件的背景下。
