School of Health Sciences, University of Southampton, Southampton, UK
Wessex Institute, University of Southampton, Southampton, UK.
BMJ Qual Saf. 2022 Jun;31(6):450-461. doi: 10.1136/bmjqs-2021-013065. Epub 2021 Aug 27.
Previous studies have detailed the technical, learning and soft skills healthcare staff deploy to deliver quality improvement (QI). However, research has mainly focused on management and leadership skills, overlooking the skills frontline staff use to improve care. Our research explored which skills mattered to frontline health practitioners delivering QI projects.
We used a theory-driven approach, informed by communities of practice, knowledge-in-practice-in-context and positive deviance theory. We used case studies to examine skill use in three pseudonymised English hospital Trusts, selected on the basis of Care Quality Commission rating. Seventy-three senior staff orientation interviews led to the selection of two QI projects at each site. Snowball sampling obtained a maximally varied range of 87 staff with whom we held 122 semistructured interviews at different stages of QI delivery, analysed thematically.
Six overarching 'Socio-Organisational Functional and Facilitative Tasks' (SOFFTs) were deployed by frontline staff. Several of these had to be enacted to address challenges faced. The SOFFTs included: (1) adopting and promulgating the appropriate organisational environment; (2) managing the QI rollercoaster; (3) getting the problem right; (4) getting the right message to the right people; (5) enabling learning to occur; and (6) contextualising experience. Each task had its own inherent skills.
Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed.
先前的研究详细介绍了医疗保健人员在提供质量改进（QI）时所运用的技术、学习和软技能。然而，研究主要集中在管理和领导技能上，忽视了一线工作人员用于改善护理的技能。我们的研究探讨了哪些技能对提供 QI 项目的一线卫生从业人员很重要。
我们使用了一种理论驱动的方法，该方法受到实践社区、实践中的知识和上下文以及正向偏离理论的启发。我们使用案例研究来检查三个化名的英国医院信托机构中技能的使用情况，这些机构是根据护理质量委员会的评级选择的。对 73 名高级员工进行了定向访谈，以在每个地点选择两个 QI 项目。雪球抽样获得了最大程度多样化的 87 名员工，我们与他们一起在 QI 交付的不同阶段进行了 122 次半结构化访谈，并进行了主题分析。
一线员工部署了六个总体的“社会组织功能和促进任务”（SOFFTs）。为了解决面临的挑战，必须执行其中的几个任务。这些 SOFFTs 包括：（1）采用和推广适当的组织环境；（2）管理 QI 过山车；（3）正确解决问题；（4）将正确的信息传达给正确的人；（5）促进学习发生；（6）使经验背景化。每个任务都有其自身固有的技能。
我们的案例研究提供了对医疗保健人员使用的技能的细致理解。虽然技术技能很重要，但判断何时以及如何使用更广泛的技能至关重要。QI 培训的提供和对改进计划的保真度可能不如部署用于克服障碍的 SOFFT 技能重要。如果无法获得这些技能和资源，QI 项目将失败。
