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首页> 外文期刊>Joint Commission Journal on Quality and Safety >Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to 'How'
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Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to 'How'

机译：在疗养院中实施一线工作者主导的质量改进：“如何”

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Background: Despite emerging frameworks for quality improvement (QI) implementation, little is known about how the implementation process works, particularly in nursing home settings. A study was conducted to describe "how"' a complex frontline worker-led QI program was implemented in nursing homes. Methods: Six focus groups were conducted in February 2017 with participants of a year-long, multicomponent, unit-level QI intervention in seven nursing homes in the Canadian province of Manitoba. Constant comparative analysis was used to examine perspectives of different groups of QI program participants—35 health care aides, health professionals, and managers. Results: Five themes important to the implementation process were identified: (1) "supportive elements of the QI program structure," (2) "navigating the workplace," (3) "negotiating relationships," (4) "developing individual skills," and (5) "observable program impact." Data on theme integration suggest that "supportive elements of the QI program structure" (Theme 1), "developing individual skills" (Theme 4), and "observable program impact" (on residents, health care aides, and leaders; Theme 5) operated as part of a reinforcing feedback loop that boosted team members' ability to navigate the workplace, negotiate relationships, and implement the QI program. Conclusion: Health care aide-led QI teams are feasible. However, a leadership paradox exists whereby worker-led QI programs also must incorporate concrete mechanisms to promote strong leadership and sponsor support to teams. The findings also point to the underexplored impact of interpersonal relationships between health care aides and professional staff on QI implementation.
机译：背景：尽管出现了用于质量改进（QI）实施的新兴框架，但对于实施过程的工作原理知之甚少，尤其是在养老院环境中。进行了一项研究，以描述在养老院中如何“实施”复杂的一线工人领导的QI项目。方法：2017年2月进行了六个焦点小组的研究，参与者为加拿大曼尼托巴省的七个疗养院，进行了为期一年，多成分，单位水平的QI干预。持续的比较分析用于检查QI项目参与者不同组的观点-35名医疗保健助手，医疗专业人员和管理人员。结果：确定了对实施过程很重要的五个主题：（1）“ QI计划结构的支持要素”，（2）“工作场所导航”，（3）“谈判关系”，（4）“发展个人技能， ”和（5）“可观察的程序影响”。关于主题整合的数据表明，“ QI项目结构的支持要素”（主题1），“开发个人技能”（主题4）和“可观察到的计划影响”（对居民，医疗助手和领导者；主题5）。作为强化反馈循环的一部分，该循环提高了团队成员导航工作场所，协商关系和实施QI计划的能力。结论：由医疗保健助手领导的QI小组是可行的。但是，存在领导悖论，即工人领导的QI计划还必须纳入具体机制，以促进强有力的领导和赞助团队支持。研究结果还指出，医护人员和专业人员之间的人际关系对QI实施的影响还不足。

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