在护理途径开发中导航价值复杂性:一个定性案例研究
Mildred Visser1, Marleen de Mul2, Kees Ahaus2
1Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands visser@eshpm.eur.nl.
BMJ open
|August 14, 2025
概括
医疗保健提供中的价值复杂性阻碍了护理途径 (CP) 的发展,导致目标不一致和延长决策. 解决这些问题需要持续的利益相关者管理和可适应的战略,以有效改善医疗保健.
科学领域:
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
- 医疗保健中的组织行为
背景情况:
- 护理途径 (CP) 对于标准化医疗保健提供至关重要,但其发展往往因价值 (或规范) 复杂性而复杂.
- 了解价值复杂性如何影响CP发展对于改善医疗保健流程至关重要.
研究的目的:
- 在护理途径开发计划中实证地探索价值复杂性的展开.
- 识别受竞争价值观和利益相关者动态影响的CP发展中的挑战和促进者.
主要方法:
- 一个定性单一案例研究,采用了两年时间的行动研究策略.
- 追溯分析使用已确定的"经验规则"进行反思.
- 数据收集包括从专业康复医院的11个多学科团队的26名受访者进行反思性对话,问卷和参与式观察报告.
主要成果:
- 目标 (错误) 调整和延长的决策过程显著阻碍了动机和CP发展.
- 提高护理质量和确保财务可行性之间的紧张关系,以及多学科团队中的角色不确定性,挑战了决策.
- 反思对话,实验和财务建模提供了部分支持,以导航这些复杂性.
结论:
- 价值复杂性对CP发展产生重大影响,强调需要持续的利益相关者管理,反射性和对话.
- 格林哈尔格和其他人. "的经验规则提供了解释价值,但需要理论基础和相互关系的意识.
- 综合反思和适应能力的复杂性知情方法可以增强CP开发方法,以建设性地参与医疗保健中复杂的变化过程.
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