目标:最近推动医院提供高价值护理的努力依赖于支付激励措施。然而,证据表明,70%到90%的绩效改进项目没有达到预期目标。因此,除了管理外部行业压力,医院需要发展绩效改进(PI)能力,使他们能够利用改进机会,有效开发和采用解决方案,并确保随着时间的推移改进的可持续性。虽然运营能力使医院能够生产和提供服务,需要更多的东西来获得和维持卓越的性能。动态能力推动运营能力的变化,以满足环境需求。动态功能还使医院能够更新和重新配置其资源以优化性能。本文提出了动态能力框架,作为开发和管理医院PI能力的适当方法,并讨论了转向由动态能力PI驱动的战略的含义。
方法:研究小组根据文献综述设计了一个半结构化访谈,以了解医院是否参与动态能力框架中概述的活动。从马萨诸塞州和新罕布什尔州医院的医院PI工作人员的便利样本中招募了9名研究参与者。去鉴定的转录本输入NVivo12定性数据分析软件,数据按照内容分析的原则进行主题索引和编码。
结果:PI结构,改进方法,各医院的弱点没有显著差异.大多数医院都有PI部门,更有可能采用由高层管理人员发起的PI项目。虽然PI员工接受了改进方法方面的培训,没有任何程序需要其他医院工作人员熟悉PI方法.常见的弱点是PI项目选择,通信,协调,从当前和以前的PI项目中学习,以及持续改进的系统方法。
结论:动态PI能力为系统地识别改进机会提供了机会,抓住并从这些机会中学习,以及更新和重新配置资源以优化性能。特设PI项目不足以使医院保持卓越的性能。提供高价值患者护理和服务的内部和外部压力要求医院超过其当前的PI努力。通过开发动态PI功能,医院将采用更系统、更有效的PI方法,这可能会导致卓越的性能。
OBJECTIVE: Recent efforts to push hospitals to provide high-value care have relied on payment incentives. However, evidence indicates that 70% to 90% of performance improvement projects do not achieve their desired goals. Therefore, in addition to managing external industry pressures, hospitals need to develop performance improvement (PI) capabilities that enable them to capitalize on improvement opportunities, effectively develop and adopt solutions, and ensure the sustainability of improvements over time. While operational capabilities enable hospitals to produce and deliver services, more is needed to attain and sustain superior performance. Dynamic capabilities drive changes in operational capabilities to meet environmental demands. Dynamic capabilities also enable hospitals to renew and reconfigure their resources to optimize performance. This paper proposes the dynamic-capabilities framework as an appropriate way to develop and manage PI capabilities in hospitals, and it discusses the implications of shifting to a strategy that is driven by dynamic-capabilities PI.
METHODS: The research team designed a semi-structured interview based on a review of the literature to understand whether hospitals were engaging in the activities outlined in the dynamic-capabilities framework. Nine study participants were recruited from a convenience sample of hospital PI staff at hospitals in Massachusetts and New Hampshire. De-identified transcripts were entered into NVivo12 qualitative data analysis software, and data were thematically indexed and coded following the principles of content analysis.
RESULTS: PI structures, improvement methodologies, and weaknesses did not vary significantly among hospitals. Most hospitals had a PI department and were more likely to adopt PI projects initiated by top management. While PI staff were trained in improvement methodologies, no programs were in place that required the rest of the hospital staff to become familiar with PI methods. Common areas of weakness were PI project selection, communication, coordination, learning from current and former PI projects, and systematic approaches to sustain improvements.
CONCLUSIONS: Dynamic PI capabilities provide an opportunity to systematically identify improvement opportunities, seize on and learn from those opportunities, and renew and reconfigure resources to optimize performance. Ad hoc PI projects are insufficient to enable a hospital to sustain superior performance. Internal and external pressures to deliver high-value patient care and services require hospitals to exceed their current PI efforts. By developing dynamic PI capabilities, hospitals will adopt a more systematic and effective approach to PI, which will likely result in superior performance.