Braam Anoek, van Wijngaarden Jeroen, Hilders Carina, Buljac-Samardzic Martina
Health Services, Management, & Organization, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Netherlands.
Reinier de Graaf Gasthuis, Delft, Netherlands.
J Multidiscip Healthc. 2024 Jul 9;17:3213-3226. doi: 10.2147/JMDH.S454903. eCollection 2024.
The complexity of healthcare is increasing, mainly due to the prevalence of multimorbidity in an ageing population. Complex care for patients with multimorbidity requires a multidisciplinary approach. Traditional physician-centered hospital structures do not facilitate the necessary multidisciplinary collaboration. European hospitals are implementing process-based hospital designs with patient- and process-oriented units to stimulate multidisciplinary collaboration. Patient-oriented units are formed based on shared patient groups and focus on care trajectories, while process-oriented units are formed based on having similar processes and focus on efficiency.
This study has two aims. First, to study the effect of introduction of these units on multidisciplinary collaboration and perceived impact (efficiency, innovation, and effectiveness). Second, to study whether there are differences between patient- and process-oriented units.
A survey-based longitudinal evaluation study was conducted in 2020 and 2022 among physicians in a Dutch hospital to measure multidisciplinary collaboration (relational coordination) and perceived impact (efficiency, innovation, and effectiveness). In addition, open questions were used to enrich the data.
Quantitative and qualitative data together suggest that physicians in patient-oriented units notice benefits from the redesign to multidisciplinary units, they perceive higher impact over time. Physicians in process-oriented units achieve a better relationship with the physicians in their unit over time, but they do not perceive impact as high as physicians in patient-oriented units.
A process-based design with patient- and process-oriented units is supportive of multidisciplinary collaboration and perceived impact, especially for physicians in patient-oriented units. Physicians in patient-oriented units are positive about the introduction of these units as they feel it contributes to better multidisciplinary patient care. As the results for physicians in process-oriented units may be less directly visible in terms of quality of care, they are less likely to see positive effects, even though their relationships are improving.
医疗保健的复杂性正在增加，这主要归因于老龄化人口中多重疾病的普遍存在。对患有多重疾病的患者进行复杂护理需要多学科方法。传统的以医生为中心的医院结构不利于必要的多学科协作。欧洲医院正在实施基于流程的医院设计，设有以患者和流程为导向的科室，以促进多学科协作。以患者为导向的科室是基于共享的患者群体形成的，专注于护理轨迹，而以流程为导向的科室是基于具有相似流程形成的，专注于效率。
本研究有两个目的。第一，研究引入这些科室对多学科协作和感知影响（效率、创新和有效性）的效果。第二，研究以患者为导向的科室和以流程为导向的科室之间是否存在差异。
2020年和2022年在一家荷兰医院对医生进行了一项基于调查的纵向评估研究，以衡量多学科协作（关系协调）和感知影响（效率、创新和有效性）。此外，还使用开放式问题来丰富数据。
定量和定性数据共同表明，以患者为导向的科室中的医生注意到重新设计为多学科科室带来的好处，随着时间推移他们感受到更高的影响。随着时间推移，以流程为导向的科室中的医生与科室中的其他医生建立了更好的关系，但他们认为影响不如以患者为导向的科室中的医生高。
具有以患者和流程为导向的科室的基于流程的设计支持多学科协作和感知影响，特别是对于以患者为导向的科室中的医生。以患者为导向的科室中的医生对引入这些科室持积极态度，因为他们认为这有助于提供更好的多学科患者护理。由于以流程为导向的科室中的医生在护理质量方面的结果可能不太直接明显，他们不太可能看到积极影响，尽管他们的关系正在改善。
