Cope D, Cox S
J Adv Nurs. 1980 Jul;5(4):371-80. doi: 10.1111/j.1365-2648.1980.tb00977.x.
The organization of the way in which hospitals and hospital staff provide a service to patients is obviously of critical importance to their effectiveness, yet it is clear that rigidities and inappropriate and ineffective procedures frequently intrude. It is commonly held that changing hospitals as organizations is difficult to acomplish, and indeed, reported attempts at such change reflect this. The project reported here was a successful attempt at changing a number of different aspects of the culture of a psychiatric hospital which included managerial practices and structure, aspects of patient care, multidisciplinary team work, and staff development. The present paper concentrates on some specific outcomes at ward level. The general pattern for bringing about change involves the collection of (valid) data and then feeding this back to the staff involved so that they can take appropriate action. The data discussed here concerned ward nursing staff's attitude to the 'climate' of the hospital, their job satisfaction and aspects of patient care. This was fed back to nursing, managerial and medical staff, and action plans were agreed to overcome the difficulties highlighted. Outcomes have included the production of ward and unit objectives and changes in treatment programmes and aspects of patient care on the wards.
医院及其工作人员为患者提供服务的组织方式，显然对其服务效果至关重要，但很明显，僵化、不恰当且无效的程序经常出现。人们普遍认为，改变医院这个组织很难实现，事实上，所报道的此类变革尝试也反映了这一点。此处报道的项目是一次成功尝试，改变了一家精神病医院文化的多个不同方面，包括管理实践与结构、患者护理方面、多学科团队协作以及员工发展。本文聚焦于病房层面的一些具体成果。实现变革的总体模式包括收集（有效）数据，然后将其反馈给相关工作人员，以便他们能够采取适当行动。这里讨论的数据涉及病房护理人员对医院“氛围”的态度、他们的工作满意度以及患者护理方面。这些数据反馈给了护理、管理和医疗人员，并商定了行动计划以克服所凸显的困难。成果包括制定了病房和科室目标，以及改变了治疗方案和病房患者护理的一些方面。
