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What is quality and how is it achieved? Practitioners' views versus quality models.

机译:什么是质量,如何实现?从业者的观点与质量模型。

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摘要

BACKGROUND: Quality improvement in healthcare organisations requires structural reorganisation and systems reform, and also the development of an appropriate organisational "culture". Beliefs and attitudes that are thought by experts to be conducive to quality improvement in hospitals include the understanding of healthcare as a complex system, recognition of the importance of coordination of healthcare processes, a positive attitude towards medical error, adherence to the concept of continuous improvement, and a central preoccupation with the patient's welfare. OBJECTIVES: To explore the ideas about quality held by hospital-based doctors and nurses in Geneva, Switzerland. METHODS: Semi-structured interviews were conducted with 21 doctors and nurses in five hospital departments to explore their ideas about the definition of quality in healthcare, their perceptions about the main barriers to achieving quality healthcare, the factors that facilitate delivery of quality healthcare, and notions of responsibility for ensuring quality healthcare. Results and CONCLUSIONS: Thematic analysis of the interview data suggested that doctors' and nurses' ideas bear little resemblance to models of quality developed by quality experts. Study participants considered quality of care to be primarily the responsibility of individual practitioners. Quality was seen as mainly dependent on the practitioners' mastery of the technical and interpersonal aspects of care. In contrast, the healthcare system was seen primarily as a source of obstacles to good quality care, providing insufficient resources and imposing an excessive administrative burden. The paper discusses the potential implications of these ideas for the implementation of quality management initiatives.
机译:背景:医疗机构的质量改善需要结构重组和系统改革,还需要发展适当的组织“文化”。专家认为有利于医院质量改善的信念和态度包括对医疗保健作为一个复杂系统的理解,对医疗保健过程协调重要性的认识,对医疗错误的积极态度,对持续改进概念的坚持,并且全神贯注于患者的福利。目的:探索瑞士日内瓦的以医院为基础的医生和护士所提出的质量观念。方法:对五个医院部门的21名医生和护士进行了半结构化访谈,以探讨他们对医疗质量定义的看法,对实现优质医疗主要障碍的看法,促进提供优质医疗的因素以及确保优质医疗保健的责任概念。结果与结论:对访谈数据的主题分析表明,医生和护士的想法与质量专家开发的质量模型几乎没有相似之处。研究参与者认为护理质量是个人从业者的主要责任。人们认为质量主要取决于医生对护理技术和人际关系的掌握程度。相比之下,医疗保健系统主要被视为提供高质量护理的障碍之源,提供的资源不足并造成过多的行政负担。本文讨论了这些想法对实施质量管理计划的潜在影响。

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