病人安全文化影响因素作用机制的路径分析

目的 筛选病人安全文化的影响因素并探索各因素对病人安全文化系统的影响机制,为更好地提高患者安全提供参考依据.方法 采用中文修订版医院病人安全文化调查表(C-HSOPSC),通过随机抽样的方法,对黑龙江省291名医院管理层人员进行现场调查,运用线性回归模型和Kendall相关系数筛选病人安全文化影响因素,利用路径分析方法探索其影响路径并建立路径模型.结果 路径分析结果表明,医院管理者的支持对病人安全文化直接影响最大,科室内团队合作也是重要的影响因素,但需要通过管理者支持才能对病人安全文化起到最大的间接作用.结论 病人安全涵盖多重维度视角,医院管理者应结合院领导的支持、科室内团队合作、非惩罚性文化、医务人员的沟通与交流等重要因素的影响路径采取相应干预措施.     

Values and strategies: management of radical organizational change in a university hospital

Managers' experiences of radical change were studied in a Norwegian university hospital, which was relocated from a traditional building to a new, high‐tech building. The university hospital was also accredited as a health promoting hospital. Thirteen managers at different levels in the organization and a personnel safety representative were interviewed as part of a trailing research project. The aim of the study was to elucidate the managers' value orientation and strategies for dealing with value tensions. A combination of a hermeneutical, reflective method and a template for quality, efficiency and integrity guided the analysis. The template was based not only on the main findings but also on the core values of a model of organizational health. The results show that clinical managers focus on quality and top managers, not unexpectedly, focus on efficiency. Managers at both levels were concerned about their own integrity, and also about the integrity of their clinician colleagues, as well as showing concern for the hospital's mission, in terms of organizational effectiveness. The discussion was conducted in terms of dominance, cycling and balancing strategies, of which the last was the most prevalent. However, sustainable strategies for dealing with value tensions also call for value‐based management and value‐conscious leadership. Copyright © 2016 John Wiley & Sons, Ltd.     

An organizational approach to understanding patient safety and medical errors

Progress in patient safety, or lack thereof, is a cause for great concern. In this article, we argue that the patient safety movement has failed to reach its goals of eradicating or, at least, significantly reducing errors because of an inappropriate focus on provider and patient-level factors with no real attention to the organizational factors that affect patient safety. We describe an organizational approach to patient safety using different organizational theory perspectives and make several propositions to push patient safety research and practice in a direction that is more likely to improve care processes and outcomes. From a Contingency Theory perspective, we suggest that health care organizations, in general, operate under a misfit between contingencies and structures. This misfit is mainly due to lack of flexibility, cost containment, and lack of regulations, thus explaining the high level of errors committed in these organizations. From an organizational culture perspective, we argue that health care organizations must change their assumptions, beliefs, values, and artifacts to change their culture from a culture of blame to a culture of safety and thus reduce medical errors. From an organizational learning perspective, we discuss how reporting, analyzing, and acting on error information can result in reduced errors in health care organizations.     

The impact of managers' perceptions of learning organizations on innovation in healthcare: sample of Turkey

Organizational learning is the process of increasing effective organizational activities through knowledge and understanding. Innovation is the creation of any product, service or process, which is new to a business unit. Significant amount of research on organizational learning place a central meaning on the fact that there is a positive relationship between organizational learning and innovation. Both organizational learning and innovation are essential for organizations to prepare for change. The aim of this study is to determine to what extent the identified learning organization dimensions are associated with innovation. The study used a quantitative non‐experimental design employing statistical analysis via multiple regression and correlation methods to identify the relationships between the variables examined. Because the research was conducted in a non‐experimental way, learning organization dimensions are referred to as predictor variables, and innovation is referred to as the criterion variable. Watkins and Marsick's Dimensions of the Learning Organization Questionnaire was used in the study. Questionnaires were distributed to 498 hospital managers and, 243 valid responses were used in this study. Therefore, 243 hospital managers working at 250 Ministry of Health (public) hospitals across Turkey participated in the study. Results demonstrate that there are significant and positive correlations between learning organization dimensions and innovation. Intercorrelations between learning organization dimensions and correlations between learning organization dimensions and innovation were average and high, respectively. Results further indicate that the dimensions of the learning organizations explained 66.5% of the variance for the innovation. Copyright © 2012 John Wiley & Sons, Ltd.     

Organisationskultur als Wettbewerbsfaktor im Krankenhaus?

Focusing on organizational culture as a “soft” factor, the authors pursue the question of how the hospital can increase its competitiveness. They attempt to determine which characteristics are present in an organizational culture that enhances the organizational members’ willingness to change and thereby increases the ability to innovate as a competitive factor. The distinction between an open and a closed organizational culture (Gebert/ Boerner 1999) serves as the basis for developing the hypothesis that a relatively open organizational culture promotes the organizational members’ willingness to change and an organization’s innovativeness and can be interpreted as a response to competitive pressure. This hypothesis is empirically tested on organizations outside the realm of hospitals. The authors then seek to find the extent to which a relatively open organizational culture is salient to innovativeness and competitiveness in hospitals as well and try to ascertain the current degree of openness in hospitals. The results of the investigation are used to draw conclusions for hospital management.     

Organizational Silence and Hidden Threats to Patient Safety

Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence.     

Perceptions of hospital safety climate and incidence of readmission

Objective. To define the relationship between hospital patient safety climate (a measure of hospitals' organizational culture as related to patient safety) and hospitals' rates of rehospitalization within 30 days of discharge. Data Sources. A safety climate survey administered to a random sample of hospital employees (n=36,375) in 2006–2007 and risk‐standardized hospital readmission rates from 2008. Study Design. Cross‐sectional study of 67 hospitals. Data Collection. Robust multiple regressions used 30‐day risk‐standardized readmission rates as dependent variables in separate disease‐specific models (acute myocardial infarction [AMI], heart failure [HF], pneumonia), and measures of safety climate as independent variables. We estimated separate models for all hospital staff as well as physicians, nurses, hospital senior managers, and frontline staff. Principal Findings. There was a significant positive association between lower safety climate and higher readmission rates for AMI and HF (p≤.05 for both models). Frontline staff perceptions of safety climate were associated with readmission rates (p≤.01), but senior management perceptions were not. Physician and nurse perceptions related to AMI and HF readmissions, respectively. Conclusions. Our findings indicate that hospital patient safety climate is associated with readmission outcomes for AMI and HF and those associations were management level and discipline specific.     

Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.     

医院员工对医院组织文化认知现状的调查与分析

目的了解员工对医院组织文化认知现状,并分析相关因素,提出对策措施,为医院今后制定合理有效的医院文化发展战略计划提供依据。方法采用配额抽样的方法抽取乌鲁木齐市3家医院的743名员工进行问卷调查。结果制度规范、竞争意识、持续发展和社会责任4个维度的得分最高,授权、组织协调、患者导向和成本控制4个维度的得分最低,职称、工作性质、本院工作年限的职工医院组织文化存在显著差异（P〈0．05）。结论加强社会责任、树立以病人为中心的理念是医院文化建设的麸同点：医院管理者应该注意激励员工将医院发展的大目标内化为自身发展的小目标,坚持“病人利益至上”,充分考虑患者的需求并积极听取患者的建议：在进行文化建设时要注重对不同岗位员工群体采取不同的激励方式。     

Avoidable perinatal deaths and obstetric health care structure in the public health care system: a case study in a city in greater metropolitan Rio de Janeiro

This paper investigates the occurrence of potentially avoidable perinatal deaths by associating failures in obstetric care with structural deficiencies in four maternity hospital comprising the local health care system in a city in Greater Metropolitan Rio de Janeiro in 1994. Information sources were a questionnaire, interview, observation, and hospital records. A theoretical organizational model was applied in data analysis. The four maternity hospitals showed problems in the three groups of factors used in this study: physical infrastructure, services, and equipment; organizational and administrative characteristics; and professional organization. In two maternity hospitals, the delay in cesarean deliveries was explained by deficiencies in the group of factors that includes facilities, services, and equipment. Health care failures directly associated with the physician were explained by high percentages of negative predisposing factors (mainly in the two private hospital), skill-related problems (more clearly in the two public hospitals), and by absence of measures for redirecting practice.     

Calendar of Meetings

Medical errors and patient safety are urgent healthcare management challenges. To date, not enough has occurred to provide a systematic organizational design framework for reducing medical errors and improving patient safety. The authors offer such a framework by integrating multiple organizational factors and using well-accepted organization theory, citing relevant empirical research studies of medical errors and patient safety to support specific organizational factors. They discuss organizational design implications and recommendations for healthcare executives.     

Designing healthcare organizations to reduce medical errors and enhance patient safety

Medical errors and patient safety are urgent healthcare management challenges. To date, not enough has occurred to provide a systematic organizational design framework for reducing medical errors and improving patient safety. The authors offer such a framework by integrating multiple organizational factors and using well-accepted organization theory, citing relevant empirical research studies of medical errors and patient safety to support specific organizational factors. They discuss organizational design implications and recommendations for healthcare executives.     

Leadership, organization and health at work: a case study of a Swedish industrial company

The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.     

新建综合性医院医护人员患者安全文化研究

目的了解某新建综合性医院医护人员患者安全文化现状,寻找薄弱环节和潜在隐患,为患者安全文化水平持续改进与不断提升提供参考依据。方法采用美国医疗服务质量和研究组织通行的患者安全问卷调查法,计算正性回答率,获得该医院患者安全文化数据,和AHRQ同类医院正性反应率进行比较。结果该医院部门/区域安全等级评分正性反应率为75.5%。差错的反馈和交流、组织文化-不断改善、科室内部团队合作3个维度为患者安全优势领域。对差错的非惩罚性处理、人员配备、不良事件上报频率、科室间团队合作4个维度,为患者安全待改进领域;正性反应率最低的维度及与AHRQ差值最大的维度差错的非惩罚性处理、不良事件报告频率,提示为制约新建医院患者安全文化建设的关键环节及影响因素。结论建立公正文化,可促进不良事件上报,提升患者安全水平。     

组织文化四因素理论在医院文化研究中的应用

医院文化是由组织文化衍生而来的,所以研究医院文化可以借鉴组织文化的理论和研究方法。组织文化四因素理论兼有定性和定量研究的优点,应用该理论诊断中山医院的文化,分析了中山医院文化的特征、优秀因素以及需要改进之处,可以科学地、有针对性地推动医院文化建设。     

Creating effective leadership for improving patient safety

Leadership has emerged as a key theme in the rapidly growing movement to improve patient safety. Leading an organization that is committed to providing safer care requires overcoming the common traps in thinking about error, such as blaming individuals, ignoring the underlying systems factors, and blaming the bureaucracy of the organization. Leaders must address the system issues that are at work within their organizations to allow individual and organizational learning to occur.     

The development of a corporate philosophy in a mental health organization

The importance of a corporate philosophy for a mental health organization is addressed in light of concepts such as organizational climate and corporate culture. The functions, benefits, and potential drawbacks of a corporate philosophy are discussed along with a review of some of the executive skills required to manage a corporate culture. A case study of the development of an organizational philosophy in a mental health organization is presented along with a sample statement of philosophy and organizational credo. Outcomes are described and implications for decision making, service delivery, and management are discussed.     

Manager-physician relationships: an organizational theory perspective

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of manager-physician relationships that encompasses all these perspectives is developed.     

Factors That Influence Line Managers' Perceptions of Hospital Performance Data

Objective. To design and test a model of the factors that influence frontline and midlevel managers' perceptions of usefulness of comparative reports of hospital performance.
Study Setting. A total of 344 frontline and midlevel managers with responsibility for stroke and medical cardiac patients in 89 acute care hospitals in the Canadian province of Ontario.
Study Design. Fifty-nine percent of managers responded to a mail survey regarding managers' familiarity with a comparative report of hospital performance, ratings of the report's data quality, relevance and complexity, improvement culture of the organization, and perceptions of usefulness of the report.
Extraction Methods. Exploratory factor analysis was performed to assess the dimensionality of performance data characteristics and improvement culture. Antecedents of perceived usefulness and the role of improvement culture as a moderator were tested using hierarchical regression analyses.
Principal Findings. Both data characteristics variables including data quality, relevance, and report complexity, as well as organizational factors including dissemination intensity and improvement culture, explain significant amounts of variance in perceptions of usefulness of comparative reports of hospital performance. The total R ² for the full hierarchical regression model=.691. Improvement culture moderates the relationship between data relevance and perceived usefulness.
Conclusions. Organizations and those who fund and design performance reports need to recognize that both report characteristics and organizational context play an important role in determining line managers' response to and ability to use these types of data.     

试论医院人文服务中的组织管理

医务人员的服务行为受到医院组织环境和管理模式的影响,即组织管理决定医院人文服务的规范性和持续性,组织驱动力也是医务人员开展服务创新的重要驱动因素。医院人文服务管理包括运营管理、服务要素管理和服务绩效管理三个方面。服务要素管理是提供的后台支撑,是服务运营管理的载体;服务运营的状态是服务要素管理效果的表现;服务运营管理和服务要素管理的质量水平要通过服务绩效来予以考核。三个因素构成了一个完整的人文服务组织管理体系,确保医院人文服务实现全员化、持续化和规范化、程序化的模式。