Solberg L I, Brekke M L, Kottke T E, Steel R P
Health Partners Research Foundation, Minneapolis, Minnesota 55440-1309, USA.
Med Care. 1998 May;36(5):625-35. doi: 10.1097/00005650-199805000-00003.
Despite much health care interest in quality and Continuous Quality Improvement, there is little quantitative information about it. The purpose of this study was to measure the attitudes, activities, and organizational cultures concerning Continuous Quality Improvement in a group of Midwestern primary care clinics.
Three surveys of the clinicians, nurses, and other staff in 44 primary care clinics in the metropolitan area of Minneapolis and St. Paul were conducted. These surveys assessed: (1) attitudes about quality improvement, (2) previous efforts in these clinics to use process improvement teams, and (3) the extent to which the clinics' organizational cultures were perceived as supporting quality. The Provider Attitude Survey was completed by clinicians and nurses; the Process Improvement Progress was completed by members of the best Continuous Quality Improvement teams, if any; and the Quality Systems Inventory was completed by all personnel.
Most of the clinical personnel reported support for various Continuous Quality Improvement concepts, but their understanding and experience were limited. Only 20 (45%) clinics had had at least one Continuous Quality Improvement team in the past, only five of the 12 teams with adequate information had completed an improvement cycle, and only seven reported improving a process with it. The mean clinic scores for quality culture were no better than those in other types of organizations.
Despite relatively favorable attitudes and some Continuous Quality Improvement activities, there appears to be a need to help clinics build skill and experience for the required care improvements.
尽管医疗保健领域对质量和持续质量改进极为关注，但关于这方面的定量信息却很少。本研究的目的是衡量一组中西部初级保健诊所中有关持续质量改进的态度、活动和组织文化。
对明尼阿波利斯和圣保罗大都市地区44家初级保健诊所的临床医生、护士及其他工作人员进行了三项调查。这些调查评估了：（1）对质量改进的态度；（2）这些诊所在过去使用流程改进团队的努力情况；（3）诊所的组织文化在多大程度上被认为支持质量。提供者态度调查由临床医生和护士完成；流程改进进展情况由最佳持续质量改进团队（若有）的成员完成；质量体系清单由所有人员完成。
大多数临床人员表示支持各种持续质量改进概念，但他们的理解和经验有限。过去只有20家（45%）诊所至少有一个持续质量改进团队，在提供了充分信息的12个团队中，只有5个完成了一个改进周期，只有7个报告称通过该团队改进了一个流程。诊所质量文化的平均得分并不比其他类型的组织更好。
尽管态度相对积极且有一些持续质量改进活动，但似乎仍有必要帮助诊所培养所需护理改进方面的技能和经验。
