改善医疗保健质量:现在是时候更新Donabedian方法,以复杂系统的角度来看待医疗保健
1London School of Hygiene & Tropical Medicine, London, UK.
概括
改善医疗保健质量需要从减少主义方法转向系统思维的范式转变. 了解医疗保健作为一个复杂的系统,揭示了质量作为一个新出现的结果,需要新的研究问题和评估方法.
科学领域:
- 医疗保健管理的管理
- 系统科学 系统科学
- 公共卫生 公共卫生
背景情况:
- 医疗保健系统被认为是复杂的系统,面临着多方面的挑战.
- 传统的质量改进框架,如Donabedian的,采用线性,缩小主义的观点.
- 这种观点忽视了复杂的医疗保健系统中护理质量的新兴性质.
研究的目的:
- 在医疗保健质量研究中,倡导从减少主义转向系统思维的范式转变.
- 促进研究问题,重点是系统层面的改进,而不是孤立的干预结果.
- 鼓励开发新的指标和评估方法来评估相互连接的医疗保健系统.
主要方法:
- 概念分析医疗保健质量作为复杂系统的新兴属性.
- 批评质量改进中的传统的减少主义方法.
- 关于系统思维框架的建议,以指导未来的研究和实践.
主要成果:
- 护理质量是一个新兴的结果,受到医疗保健系统内的众多相互作用和不确定性的影响.
- 减少主义方法未能捕捉到理解和提高医疗保健质量所必需的复杂性和相互联系.
- 系统思维方法为解决复杂的医疗保健问题提供了更全面的视角.
结论:
- 过渡到系统思维对于推动医疗保健质量改善至关重要.
- 未来的研究必须优先考虑理解医疗保健作为一个相互关联的整体.
- 采用系统方法将推动医疗保健研究和实践的创新.
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