Côté André, Abasse Kassim Said, Laberge Maude, Gilbert Marie-Hélène, Breton Mylaine, Lemaire Célia
Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.
Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.
BMC Health Serv Res. 2021 Apr 1;21(1):299. doi: 10.1186/s12913-021-06299-2.
The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists' level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement.
We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview.
Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed.
Beyond simply identifying the underlying dynamics of orthopedists' involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.
在过去几年中，医院治理的迅速转变表明，骨科医生更多地参与管理角色，将对医疗服务的效率和效果产生广泛的益处。本文通过考察骨科医生的参与程度、描述这种参与的影响，并指出其他医护人员对骨科医生参与的主要反应，分析了骨科医生参与三种骨科护理途径临床活动管理的动态情况。
我们根据加拿大一家大学医院中心的治理水平选择了四个对比案例。我们使用半结构化访谈记录了骨科医生参与临床活动管理的机构动态，直到第37次访谈达到数据饱和。
我们的研究结果显示了骨科医生参与临床活动的四个级别（不活跃、被动、有贡献和积极）。鉴于骨科手术的基本性质，存在：（i）一些决策无法提前规划的活动，以及（ii）其他一些决策可以提前规划的活动。对意外事件的管理需要骨科医生比可规划事件的管理更高程度的参与。
本研究不仅简单地确定了骨科医生参与临床活动的潜在动态，还分析了这种参与如何影响管理活动和患者的护理质量结果。
