背景:基于家庭的医疗保健被认为对全球医疗保健系统的可持续性至关重要。在家庭护理的背景下,然而,由于容易出错的药物管理流程和普遍的医疗保健相关感染,可能会发生不良事件,falls,和压疮。在处理任何形式的风险时,对于领导者来说,建立对正在发生的事情和危急关头的共同情境意识是至关重要的,以实现良好的结果。这项研究的总体目标是获得有关领导者在家庭护理服务中的风险感知和适应能力的经验知识。
方法:本研究采用多案例研究设计。我们调查了风险认知,领导力,感官制造,以及挪威三个城市家庭护理服务背景下的决策。23位领导人接受了采访。使用主题分析对数据材料进行了分析,并从想象中的工作与完成中的弹性角度进行了解释。
结果:对家庭护理服务的需求不断增加,工人努力满足社会对家庭护理责任的高期望。领导者发现自己试图在这些紧迫的条件下与感知的风险保持一致。从分析数据中出现的主题是:“风险和质量被概念化为专业工作的组成部分”,“感知和评估风险意味着相互讨论和咨询——没有人能独自做到这一点”和“领导者保持冷静,通过在系统内外操纵来超越预算和质量措施”。对患者健康的不同看法表明,领导者负有很大的责任,为每个家庭患者健康和充分地组织医疗保健。尽管领导人没有使用风险这个词,讨论问题和相互咨询是家庭护理领导者的专业精神的重要组成部分。
结论:领导者构建风险图景的基础是使用多个信号,如可测量的生命体征和患者对健康状况的口头和非口头表达。这些发现意味着需要更多研究如何从复原力的角度更好地实施国家指导方针和质量措施。其中,更好地调整想象工作和完成工作的适应能力对于提供高质量的家庭护理服务至关重要。
BACKGROUND: Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders\' risk perception and adaptive capacity in homecare services.
METHODS: The study applied a multiple
case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a
resilience perspective of work-as-imagined versus work-as-done.
RESULTS: There is an increased demand on homecare services and workers\' struggle to meet society\'s high expectations regarding homecare\'s responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: \'Risk and quality are conceptualized as integral to professional work\', \'Perceiving and assessing risk imply discussing and consulting each other- no one can do it alone\' and \'Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system\'. Different perspectives on patients\' well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders\' sense of professionalism.
CONCLUSIONS: The leaders\' construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients\' verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a
resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.