决定护理一致性和护理质量的时间结构:超急性期中风服务案例研究。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Georgia B Black, Angus I G Ramsay, Robert Simister, Abigail Baim-Lance, Jeannie Eng, Mariya Melnychuk, Naomi J Fulop
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引用次数: 0

摘要

背景:时间结构由实践和社会规范决定,并影响护理质量和时间安排。在这项对提供卒中初步调查、治疗和护理的超急性期卒中病房的案例研究中,我们探究了时间结构模式,以解释这些模式如何影响护理质量:本文对与超急性期卒中员工的定性访谈(n=76)、非参与观察(n=41,约 102 小时)以及相关服务标准指南的文件分析进行了专题分析。我们采用归纳编码的方法,围绕时间结构的概念得出了专题研究结果,并附有图解实例:结果:五个时间结构影响了 "何时发生何事":(1) 临床优先事项和质量保证指标促使迅速开展延长生命的初步评估和干预活动;(2) 病房组织的静态特征,如轮班和查房,影响护理的一致性,决定为患者提供护理的时间和质量;(3) 一些服务机构尝试使用员工轮班来满足高峰需求,有时并不成功;(4) 隐性的社会规范或启发式的必要性认识影响了员工对护理一致性做出改变或改进的积极性,尤其是周末工作;以及 (5) 瓶颈或积压等后遗症影响了护理质量,而这些后遗症很难有效衡量以推动服务改进。结论:患者需要时间上一致的高质量医疗服务。时间一致性源于服务设计,包括人员配备、目标和患者路径设计,以及对工作模式的文化态度。如果不改变轮班和查房等结构,以及某些专业群体周末工作的社会规范,护理一致性的改善将是有限的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services.

Background: Temporal structuring is determined by practices and social norms and affects the quality and timing of care. In this case study of hyperacute stroke wards which provide initial stroke investigation, treatment and care, we explored temporal structuring patterns to explain how these may affect quality of care.

Methods: This paper presents a thematic analysis of qualitative interviews with hyperacute stroke staff (n=76), non-participant observations (n=41, ~102 hours) and documentary analysis of the relevant service standards guidance. We used an inductive coding process to generate thematic findings around the concept of temporal structuring, with graphically illustrated examples.

Results: Five temporal structures influence what-happens-when: (1) clinical priorities and quality assurance metrics motivate rapid activity for the initial life-prolonging assessments and interventions; (2) static features of ward organisation such as rotas and ward rounds impact consistency of care, determining timing and quality of care for patients; (3) some services experimented with staff rotas to try to meet peaks in demand, sometimes unsuccessfully; (4) implicit social norms or heuristics about perceived necessity affected staff motivation to make changes or improvements to consistency of care, particularly around weekend work; and (5) after-effects such as bottlenecks or backlogs affect quality of care, which are hard to measure effectively to drive service improvement.

Conclusions: Patients need temporally consistent high quality of care. Temporal consistency stems from the design of services, including staffing, targets and patient pathway design as well as cultural attitudes to working patterns. Improvements to consistency of care will be limited without changes to structures such as rotas and ward rounds, but also social norms around weekend work for certain professional groups.

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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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