Department of Communication, Quality Management, and Information Systems, Mid Sweden University, Östersund, Sweden
Department of Pediatrics, Region Västernorrland, Härnösand, Sweden.
BMJ Open Qual. 2024 Apr 2;13(2):e002566. doi: 10.1136/bmjoq-2023-002566.
Healthcare organisations strive to meet their current and future challenges and need to increase their capacity for continuous organisational improvement and learning (COIL). A key aspect of this capacity is the development of COIL capability among employees.
This systematic review aims to explore common attributes of interventions that contribute to the development of COIL capability in healthcare organisations and to explore possible facilitating and hindering factors.
A comprehensive search was conducted in Scopus, MEDLINE and Business Source Complete for primary research studies in English or Swedish, in peer-reviewed journals, focusing on organisational improvements and learning in healthcare organisations. Studies were included if they were published between 2013 and 23 November 2022, reported outcomes on COIL capability, included organisations or groups, and were conducted in high-income countries. The included articles were analysed to identify themes related to successful interventions and factors influencing COIL capability.
Thirty-six articles were included, with two studies reporting unsuccessful attempts at increasing COIL capability. The studies were conducted in nine different countries, encompassing diverse units, with the timeframes varying from 15 weeks to 8 years, and they employed quantitative (n=10), qualitative (n=11) and mixed methods (n=15). Analysis of the included articles identified four themes for both attributes of interventions and the factors that facilitated or hindered successful interventions: (1) engaged managers with a strategic approach, (2) external training and guidance to develop internal knowledge, skills and confidence, (3) process and structure to achieve improvements and learning and (4) individuals and teams with autonomy, accountability, and safety.
This review provides insights into the intervention attributes that are associated with increasing COIL capability in healthcare organisations as well as factors that can have hindering or facilitating effects. Strategic management, external support, structured processes and empowered teams emerged as key elements for enhancing COIL capability.
医疗机构努力应对当前和未来的挑战，需要提高持续组织改进和学习（COIL）的能力。这种能力的一个关键方面是在员工中发展 COIL 能力。
本系统评价旨在探讨有助于医疗机构 COIL 能力发展的干预措施的共同属性，并探讨可能的促进和阻碍因素。
在 Scopus、MEDLINE 和 Business Source Complete 中进行了全面搜索，以查找英语或瑞典语的同行评审期刊中关于医疗机构组织改进和学习的原始研究。如果研究报告了 COIL 能力的结果，包括组织或团体，并在高收入国家进行，则将其纳入研究。对纳入的文章进行分析，以确定与成功干预相关的主题和影响 COIL 能力的因素。
共纳入 36 篇文章，其中 2 篇文章报告了增加 COIL 能力的不成功尝试。这些研究在九个不同的国家进行，涵盖了不同的单位，时间范围从 15 周到 8 年不等，采用了定量（n=10）、定性（n=11）和混合方法（n=15）。对纳入文章的分析确定了干预措施的属性以及促进或阻碍成功干预的因素的四个主题：（1）具有战略方法的参与经理，（2）外部培训和指导以发展内部知识、技能和信心，（3）实现改进和学习的过程和结构，以及（4）具有自主权、问责制和安全性的个人和团队。
本综述提供了关于与增加医疗机构 COIL 能力相关的干预措施属性以及可能具有阻碍或促进作用的因素的见解。战略管理、外部支持、结构化流程和授权团队成为增强 COIL 能力的关键要素。
