Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany.
Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), 50935 Cologne, Germany.
Int J Environ Res Public Health. 2020 Nov 2;17(21):8074. doi: 10.3390/ijerph17218074.
Health and social care organizations are under pressure of organizing care around patients' needs and preferences while complying with regulatory frameworks and constraint resources. To implement patient-centered care in health and social care organizations successfully, particular organizational preconditions need to be considered. Findings on the implementation of patient-centered care and its preconditions are rare and insufficiently account for the organizational context to explain differences. This study examines the implementation status of patient-centered care in diverse health and social care organizations and analyzes the communication climate as a precondition of successful implementation. In a cross-sectional postal key informant survey, decision makers in the highest leading positions from six different types of health and social care organizations in Cologne, Germany, were surveyed using a paper-pencil questionnaire. Patient-centered care implementation was operationalized by three categories (principles, activities, and enablers) including 15 dimensions. Organizational communication climate was operationalized by aspects of open and constructive communication, cooperation, and inclusion. Out of 1790 contacted organizations, 237 participated. In the analyses, 215 complete datasets were included. Descriptive analyses, Kruskal-Wallis test, post hoc pair-wise test, and linear regression modeling were performed. Results show that the implementation status of patient-centered care was perceived as high but differed between the various types of organizations and in terms of patient-centered care categories. Organizational communication climate was significantly associated with the implementation of patient-centered care. Especially in organizations with a higher number of employees, strategies to create a positive communication climate are needed to create a precondition for patient-centered care.
医疗和社会保健组织面临着在满足监管框架和资源限制的同时,围绕患者需求和偏好组织护理的压力。为了成功地在医疗和社会保健组织中实施以患者为中心的护理,需要考虑特定的组织前提条件。关于以患者为中心的护理的实施及其前提条件的研究结果很少,并且不足以考虑组织背景来解释差异。本研究考察了不同医疗和社会保健组织中以患者为中心的护理的实施情况,并分析了沟通氛围作为成功实施的前提条件。在一项跨部门的邮政关键信息员调查中,使用纸质问卷对德国科隆的六种不同类型的医疗和社会保健组织的最高领导层的决策者进行了调查。以患者为中心的护理实施通过包括 15 个维度的三个类别(原则、活动和促进因素)来操作。组织沟通氛围通过开放和建设性沟通、合作和包容的方面来操作。在联系的 1790 个组织中,有 237 个组织参与了调查。在分析中,纳入了 215 个完整的数据集。进行了描述性分析、Kruskal-Wallis 检验、事后两两检验和线性回归建模。结果表明,以患者为中心的护理实施情况被认为是高水平的,但在各种类型的组织之间以及在以患者为中心的护理类别方面存在差异。组织沟通氛围与以患者为中心的护理实施显著相关。特别是在员工人数较多的组织中,需要制定积极沟通氛围的策略,为以患者为中心的护理创造前提条件。