ABSTRACT
BACKGROUND: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. METHOD: Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. RESULTS: A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. CONCLUSIONS: Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.
Subject(s)
Hospitals/standards , Quality Improvement/standards , Quality Indicators, Health Care/organization & administration , Anesthesia Department, Hospital/standards , France , Group Practice/standards , Humans , Patient Care Team/standards , Qualitative ResearchABSTRACT
The analysis of conversational turn-taking and its implications on time (the speaker cannot completely anticipate the future effects of her/his speech) and sociality (the speech is co-produced by the various speakers rather than by the speaking individual) can provide a useful basis to analyze complex organizing processes and collective action: the actor cannot completely anticipate the future effects of her/his acts and the act is co-produced by multiple actors. This translation from verbal to broader classes of interaction stresses the performativity of speeches, the importance of the situation, the role of semiotic mediations to make temporally and spatially distant "ghosts" present in the dialog, and the dissymmetrical relationship between successive conversational turns, due to temporal irreversibility.
Subject(s)
Verbal Behavior , Humans , Models, Psychological , Social Behavior , SpeechABSTRACT
La actividad y las ténicas del control de gestión van a verse sometidas a unos cambios tan drásticos como no se habían visto desde la década de los años veinte. Además, el dominio de estas técnicas pasarán a ser un elemento esencial de la diferenciación competitiva en el mercado mundial, uno de los factores que determinan ganar o perder, con la misma importancia que la tecnología del producto o que el proceso de producción. De hecho, se trata de lo más moderno de la gestión que se va a elaborar a nivel internacional, a través de la reconcepción de los instrumentos de medida, un ámbito en el que las prácticas estaban bien establecidas, aunque un poco anquilosadas desde hace varias décadas. El elemento clave de este avance de la gestión es la gestión por actividades, una nueva filosofía de control y un conjunto de herramientas que se derivan de ella, para ser utilizadas "a la carta"
