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首页> 外文OA文献 >Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and\ud in-depth qualitative case studies
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Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and\ud in-depth qualitative case studies

机译：有效的董事会安全护理董事会治理：通过国家定量调查和\ ud对关系的广度和深度进行（理论上支持）横断面检查 深入的定性案例研究

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Background: Recent high-profile reports into serious failings in the quality of hospital care in the NHS raise concerns over the ability of trust boards to discharge their duties effectively.\ud\udObjectives: Our study aimed to generate theoretically grounded empirical evidence on the associations between board governance, patient safety processes and patient-centred outcomes. The specific aims were as follows: (1) to identify the types of governance activities undertaken by hospital trust boards in the English NHS with regard to ensuring safe care in their organisation; (2) in foundation trusts, to explore the\udrole of boards and boards of governors with regards to the oversight of patient safety in their organisation;\ud(3) to assess the association between particular hospital trust board oversight activities and patient safety processes and clinical outcomes; (4) to identify the facilitators and barriers to developing effective hospital trust board governance of safe care; and (5) to assess the impact of external commissioning arrangements and incentives on hospital trust board oversight of patient safety.\ud\udMethods: The study comprised three distinct but interlocking strands: (1) a narrative systematic review in order to describe, interpret and synthesise key findings and debates concerning board oversight of patient safety; (2) in-depth mixed-methods case studies in four organisations to assess the impact of hospital board governance and external incentives on patient safety processes and outcomes; and (3) two national surveys exploring board management in NHS acute and specialist hospital trusts in England, and relating board characteristics to whole-organisation outcomes.\ud\udResults: A very high proportion of trust boards reported the kinds of desirable characteristics and board-related processes that research says may be associated with higher performance. Our analysis of the symbolic aspects of board activities highlights the role and differences in local processes of organising the governance of patient safety. Most boards do allocate considerable amount of time to discussing patient safety and quality-related issues and were using a wide range of hard performance metrics and soft intelligence to monitor its organisation with regard to patient safety. Although the board of governors is generally perceived to be well-meaning, they were also considered to be being largely ineffective in helping to promote and deliver safer care for their organisations. We did not find any statistically significant relationship between board attributes (self-reported) and processes and any patient safety outcome measures. However, we did find a significant relationship between two dimensions of the Board Self-Assessment Questionnaire and two specific-and-related national staff survey organisational ‘process’ measures: (1) staff feeling safe to raise concerns about errors, near-misses and incidents and (2) staff feeling confident that their organisation would address their concerns, if raised. We also found that contracting and external financial incentives appeared to play only a relatively minor role in incentivising quality and safety improvement.\ud\udConclusions: Our research is the first large-scale mixed-methods study of hospital board activity and behaviour related to the oversight of patient safety in the English NHS and the key findings should be used to influence the design of future governance arrangements as well as the training and support of board.\ud\udFunding: The National Institute for Health Research Health Services and Delivery Research programme.
机译：背景：最近关于NHS医院护理质量严重缺陷的备受瞩目的报道引起了人们对信托委员会有效履行职责能力的担忧。\ ud \ ud目标：我们的研究旨在为协会建立理论基础的经验证据在董事会治理，患者安全流程和以患者为中心的结果之间。具体目标如下：（1）确定英国NHS中医院信托委员会为确保其组织的安全护理而开展的治理活动的类型； （2）在基金会信托中，探索董事会和州长理事会对组织中患者安全监督的职责； \ ud（3）评估特定医院信托委员会监督活动与患者安全流程之间的关联和临床结果； （4）找出促进医院信任委员会有效管理安全护理的促进因素和障碍； （5）评估外部委托安排和激励措施对医院信任委员会监督患者安全的影响。\ ud \ ud方法：该研究包括三个截然不同但相互联系的环节：（1）叙述性系统综述，以描述，解释并综合有关董事会对患者安全监督的主要发现和辩论； （2）在四个组织中进行深入的混合方法案例研究，以评估医院董事会管理和外部激励措施对患者安全过程和结果的影响； （3）两次全国性调查，探讨英格兰NHS急症和专科医院信托中的董事会管理，并将董事会特征与整个组织的结果相关。\ ud \ ud结果：非常高比例的信托委员会报告了理想特征和董事会的种类研究认为与过程相关的过程可能与更高的性能相关。我们对董事会活动的象征意义的分析突出了组织患者安全治理的本地流程中的作用和差异。大多数委员会确实分配了大量时间来讨论患者安全和与质量相关的问题，并且正在使用各种硬绩效指标和软情报来监视其组织在患者安全方面的情况。尽管人们普遍认为理事会是善意的，但他们也被认为在帮助促进和为其组织提供更安全的护理方面效率低下。我们没有发现董事会属性（自我报告）和流程与任何患者安全结果指标之间的任何统计学上显着的关系。但是，我们的确发现了董事会自我评估调查问卷的两个维度与两个与具体和相关的国家员工调查组织的“过程”措施之间的显着关系：（1）工作人员感到放心地对错误，差错和失败提出了担忧。事件和（2）员工有信心他们的组织将解决他们的担忧（如果提出）。我们还发现，签约和外部财务激励措施在激励质量和安全性改善方面似乎只发挥了相对较小的作用。\ ud \ ud结论：我们的研究是第一项大规模的混合方法研究，涉及医院董事会活动和行为与应当使用英语NHS中的患者安全监督和主要发现来影响未来治理安排的设计以及董事会的培训和支持。 。

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