Silvola Sofia, Restelli Umberto, Croce Davide, Basu Debashis
LIUC - Università Cattaneo, Castellanza, VA, Italy.
Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
J Prev Med Hyg. 2024 Oct 31;65(3):E410-E433. doi: 10.15167/2421-4248/jpmh2024.65.3.3023. eCollection 2024 Sep.
The introduction of process innovations in healthcare organizations faces challenges in knowledge sharing and incorporating best practices due to a strong professional autonomy, leading to resistance to change. The healthcare paradigm is shifting towards value-based organizations with a patient-centered approach, requiring multidisciplinary care. Change management is crucial, but current approaches are often limited. This study proposes a conceptual framework to support change management in healthcare services redesign.
The proposed conceptual framework was developed applying Jabareen's multidimensional and multi-method approach. The methodology involved 8 steps consisting in literature review, thematic and content analyses, concepts deconstruction and aggregation, graphical design of the framework, external validation and revision.
The framework integrates 53 evidences from the literature, 3 macro areas of interest and 42 change management models applied to the healthcare context, through 244 implementation actions. Aggregation of concepts led to 15 macro topics applicable to all levels of change and composing the proposed framework. Interviews validated the framework, emphasizing the importance of people-focused approaches and addressing resistance to change. Moreover, steps most and less cited in the literature are highlighted and differences between developed countries and economies in transition or developing countries are explored.
The article proposes a 15-step framework for change in healthcare services redesign. It integrates evidence from literature and change management models, emphasizing stakeholder involvement. A case study in South Africa highlights the importance of awareness, planning, communication, training, and continuous review. Further validation and adaptation are recommended.
由于强大的专业自主性，医疗保健组织引入流程创新在知识共享和纳入最佳实践方面面临挑战，导致对变革的抵制。医疗保健范式正在转向以患者为中心的基于价值的组织，需要多学科护理。变革管理至关重要，但目前的方法往往有限。本研究提出了一个概念框架，以支持医疗服务重新设计中的变革管理。
所提出的概念框架是采用贾巴林的多维和多方法方法开发的。该方法包括8个步骤，包括文献综述、主题和内容分析、概念解构和汇总、框架的图形设计、外部验证和修订。
该框架通过244项实施行动，整合了来自文献的53条证据、3个感兴趣的宏观领域和42个应用于医疗保健背景的变革管理模型。概念的汇总产生了15个适用于所有变革层面并构成所提出框架的宏观主题。访谈验证了该框架，强调了以人为本方法的重要性以及应对变革阻力的重要性。此外，突出了文献中引用最多和最少的步骤，并探讨了发达国家与转型经济体或发展中国家之间的差异。
本文提出了一个用于医疗服务重新设计变革的15步框架。它整合了来自文献和变革管理模型的证据，强调利益相关者的参与。南非的一个案例研究突出了意识、规划、沟通、培训和持续审查的重要性。建议进行进一步的验证和调整。
