Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada.
J Health Organ Manag. 2021 Jan 7;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-09-2020-0370.
This paper examines how "quality" was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of "quality" and (2) To explore how frames of quality and the framing process may have influenced policy implementation.
DESIGN/METHODOLOGY/APPROACH: The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.
The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.
ORIGINALITY/VALUE: As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how "quality" is framed in the context of these policies and with what effect. This is the first framing analysis of "quality" in health policy.
本文考察了在改革医院资金和相关医疗服务提供的政策设计和实施过程中，“质量”是如何被构建的。本研究的目的是：(1) 描述政策设计者和政策执行者（管理者和临床医生）如何构建“质量”的概念；(2) 探讨质量框架和框架构建过程如何影响政策的实施。
设计/方法/途径：作者对加拿大安大略省一项基于质量的程序政策的设计和实施的定性案例研究中的数据进行了二次分析，该研究包括对 45 名有目的选择的关键信息者进行半结构化访谈。作者使用框架理论来指导编码和分析。
政策设计者构建的质量框架比执行者更为广泛，而执行者的质量框架则较为狭隘。框架分歧进一步体现在信息提供者对质量的临床和财务领域之间关系的构建上。一些环境和组织因素影响了执行者对质量的构建方式。
原创性/价值：随着全球卫生系统越来越多地采用新的治理和融资模式来加强医疗服务质量，有必要考虑这些政策背景下的“质量”是如何被构建的，以及其产生的影响。这是对卫生政策中“质量”的首次框架分析。
