RESUMEN
The organisation of production of care is a task that requires three different levels of competence: operational, structural and learning skills. The organisational requirements (OR) of the Head Nurse (HN) are often centered on the operational level, to the detriment of the other two levels. This difficulty is due to the organisation which presents limited political, cognitive and pragmatic levels of rationality.The aim of this study was to identify the impact of a third party in relation to the organisation and its effect on the HN's OR. An educational device places HN students in the position of a third party to allow them to work on an organisational problem delegated by a HN. The research-intervention followed 17 projects over a period of one year.Intervention by a third party legitimised the problem by recognizing the difficulties in nursing and reconfiguring relations between healthcare professionals in a political dimension. The methods employed by the third party reassured the HN and completed their knowledge, placing particular focus on the importance of methodology and managerial posture. In practice, the third party supported the HN's power to act and coordinate the various members of the team. The third party contributes to the development of the HN's OR and completes certain limits of the HN's rationality. Nevertheless, difficulties still remain in the development of practices outside the medical team, limiting the extension to other services.A unit managerial support, a collective schedule and open spaces of discussion are recommended to bring structure and support to the OR.
Asunto(s)
Supervisión de Enfermería/organización & administración , Educación en Enfermería , Francia , HumanosRESUMEN
The work of operational coordination led by head nurses (HN) is more known than their abilities to change work organization, as well as, care practices. In this article, we explore organizational projects led by HN. Depending on the situations, they may concern their health care team or involve institutional hierarchy or other teams. We rely on an intervention study, which enabled us to follow 17 organizational projects led by HN for one year. The results of this study highlight as the main condition for success, the HN' efforts to enable mutual understanding with other interested actors. Managers, who engage their health care team in the development of solutions, bring sustainable results. When problems involve the hierarchy, the managers focus on the development of personal relationships. When problems involve other departments, which they depend on, then they engage themselves into integrative negotiations. These results invite to open discussion about work organization and to formalize organizational projects. This intervention study also points out that work - training at operational audit is relevant for HN. Activé par Editorial Manager® et ProduXion.
Asunto(s)
Supervisión de Enfermería/organización & administración , Educación en Enfermería , Investigación CualitativaRESUMEN
Introduction : project management is on the expected proficiencies for head nurses. Context : The work on the organizations' improvement carried out by head nurses, is rarely covered in the literature. Objectives : to follow the implementation of actions from projects led by head nurses and to analyze the parameters of success. Method : for a year, an intervention study has followed 17 projects initiating improvement measures. Semistructured interviews were conducted with health-care teams and managers. All of them reported the results of the implementation of each measure as an operational improvement. A mixed analysis containing a logistic regression investigated associations between the result of the action and the various contextual characteristics. Results : this study involved 111 actions. 71 % of them concluded an operational improvement. The organizational and supporting actions had a high success rate, which decreased when hazards were not managed by healthcare managers. Discussion : this study highlights the place of strategies through the implementing methods and the chosen actions. Recommendations are made in order to promote a collective assessment. Conclusion : scientific approaches are proposed to discuss the organizational work.
Asunto(s)
Atención a la Salud , Liderazgo , Salud Pública/educación , Mejoramiento de la Calidad , Atención a la Salud/organización & administración , Atención a la Salud/normas , Educación Médica Continua/métodos , Educación Médica Continua/organización & administración , Humanos , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normas , Recursos HumanosRESUMEN
OBJECTIVES: This study evaluated a strategy for implementing continuous quality improvement based on a decentralized quality management system in the clinical departments of a hospital. SETTING: The institution is a 2000-bed teaching hospital of tertiary health care employing 8000 people. METHODS: The quality management intervention was tested in six volunteer departments. This intervention comprised an instructional seminar, methodological assistance, and the dissemination of guidelines. The program was evaluated 1 year after the intervention and included a quality audit, interviews with department staff, and analysis of the written documents produced by the departments. RESULTS: The quality management systems are functioning in all the departments. Quality teams meet regularly and multidisciplinary work groups are in place. The topics most often addressed are patient reception and communication between department staff members. The level of compliance with the guidelines has increased, from 39% before the seminar to 54% 1 year later (P < 0.05). All of the staff members interviewed judged the process useful for them and for the department, while waiting for the concrete results. Among the difficulties the staff members encountered were changing their work habits, lack of time, and the tedious aspect of writing procedures. CONCLUSION: Implementing continuous quality improvement in hospital departments seems to be an interesting alternative to organization-wide implementation strategies. However, these results need to be confirmed by long-term evaluations and by deploying the program i n other departments.