Understanding staff perspectives of quality in practice in healthcare

BMC Health Services Research

Peter Cressey¹  Michelle Farr¹ 

[1] Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK

关键词: Values;    Services management;    Reflection;    Quality improvement;    Patient experience;    Human relations;    Francis report;    Customer-oriented bureaucracy;   

Others  :  1174779
DOI  :  10.1186/s12913-015-0788-1

 received in 2014-07-28, accepted in 2015-03-13,  发布年份 2015

【 摘 要 】

Background

Extensive work has been focussed on developing and analysing different performance and quality measures in health services. However less has been published on how practitioners understand and assess performance and the quality of care in routine practice. This paper explores how health service staff understand and assess their own performance and quality of their day to day work. Asking staff how they knew they were doing a good job, it explored the values, motivations and behaviours of staff in relation to healthcare performance. The paper illustrates how staff perceptions of quality and performance are often based on different logics to the dominant notions of performance and quality embedded in current policy.

Methods

Using grounded theory and qualitative, in-depth interviews this research studied how primary care staff understood and assessed their own performance and quality in everyday practice. 21 people were interviewed, comprising of health visitors, occupational therapists, managers, human resources staff and administrators. Analytic themes were developed using open and axial coding.

Results

Diverse aspects of quality and performance in healthcare are rooted in differing organisational logics. Staff values and personal and professional standards are an essential element in understanding how quality is co-produced in everyday service interactions. Tensions can exist between patient centred, relational care and the pressures of efficiency and rationalisation.

Conclusions

Understanding the perspectives of staff in relation to how quality in practice develops helps us to reflect on different mechanisms to manage quality. Quality in everyday practice relies upon staff values, motivations and behaviours and how staff interact with patients, putting both explicit and tacit knowledge into specific action. However organisational systems that manage quality often operate on the basis of rational measurement. These do not always incorporate the intangible, relational and tacit dimensions of care. Management models need to account for these relational and experiential aspects of care quality to support the prioritisation of patients’ needs. Services management, knowledge management and ethics of care literature can provide stronger theoretical building blocks to understand how to manage quality in practice.

【 授权许可】

   
2015 Farr and Cressey; licensee BioMed Central.

【 参考文献 】

• [1]De Silva D: Helping measure person-centred care. The Health Foundation, London; 2014.
• [2]National Quality Board: Quality in the new health system. London: Department of Health; 2013. [Quote p.7]
• [3]Institute of Medicine: Crossing the quality chasm: a new health system for the 21st century. National Academies Press, Washington, DC; 2001.
• [4]Doyle C, Lennox L, Bell D: A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. British Medical Journal Open 2013, 3(1):e001570.
• [5]Murrells T, Robert G, Adams M, Morrow E, Maben J: Measuring relational aspects of hospital care in England with the ‘patient evaluation of emotional care during hospitalisation’ (PEECH) survey questionnaire. British Medical Journal Open 2013, 3:e002211.
• [6]Hood C: A public management for all seasons? Public Adm 1991, 69(Spring):3-19.
• [7]Le Grand J: Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens. Oxford University Press, Oxford; 2003.
• [8]Leatherman S, Sutherland K: The Quest for Quality in the NHS: A mid-term evaluation of the ten-year quality agenda. Nuffield Trust, London; 2003.
• [9]Osborne S: Delivering public services: Time for a new theory? Public Management Review 2010, 12(1):1-10.
• [10]Osborne S: (Ed): The New Public Governance. Routledge, London; 2010.
• [11]Weber M: Economy and Society. University of California Press, Berkeley; 1978.
• [12]Cooper C: Message from the Chair: “Never mind the targets, feel the quality! Quality Improvement Network News. Royal College of Nursing, London; 2003.
• [13]Terry LD: From Greek Mythology to the real world of the new public management and democratic Governance (Terry Responds). Public Adm Rev 1999, 59(3):272-276.
• [14]Taylor FW: The principles of scientific management. Harper and Brothers, New York; 1911.
• [15]Sugden R: What public choice and Philosophy should not learn from one another. American Journal of Economics and Sociology 2004, 63(1):207-211.
• [16]Alford J: Engaging Public Sector Clients: From service delivery to co-production. Basingstoke, Palgrave Macmillan; 2009.
• [17]Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000, 55(1):68-78.
• [18]Deci EL, Ryan RM: Self-Determination theory: A Macrotheory of human motivation, Development, and Health. Can Psychol 2008, 49(3):182-185.
• [19]Ackroyd S, Bolton S: It is not Taylorism: Mechanisms of work intensification in the provision of Gynaecological services in a NHS hospital. Work Employ Soc 1999, 13(2):369-387.
• [20]Newman J: Modernising governance: New Labour, policy and society. Sage, London; 2001.
• [21]Department of Health Workforce Directorate: NHS Partners, Manchester University: HR High Impact Changes: An evidence based resource. Department of Health, London; 2006.
• [22]Michie S, West MA: Managing people and performance: an evidence based framework applied to health service organisations. International Journal of Management Reviews 2004, 5/6(2):91-111.
• [23]Purcell J, Kinnie N, Hutchinson S, Rayton B, Swart J: Understanding the People and Performance Link: Unlocking the Black Box. CIPD, London; 2003.
• [24]West M, Dawson J, Admasachew L, Topakas A: NHS Staff Management and Health Service Quality: Results from the NHS Staff Survey and Related Data. London: Department of Health.
• [25]Purcell J, Kinnie N: HRM and Business Performance. In The Oxford Handbook of Human Resource Management. Edited by Boxall P, Purcell J, Wright P. Oxford: Oxford University Press; 2007: 533–551.
• [26]Iles V: Why Reforming the NHS Doesn’t Work: The importance of understanding how good people offer bad care. [http://www.reallylearning.com/Free_Resources/MakingStrategyWork/reforming.pdf]
• [27]Mol A: The Logic of Care. Routledge, Abingdon; 2008.
• [28]De Zulueta P: Compassion in 21st century medicine: Is it sustainable? Clinical Ethics 2013, 8(4):119-128.
• [29]Osborne SP, Radnor Z, Nasi G: A new theory for public service management? Toward a (public) service-dominant approach. The American Review of Public Administration 2013, 43(2):135-158.
• [30]Vargo SL, Maglio P, Akaka M: On value and value co-creation: A service systems and service logic perspective. Eur Manag J 2008, 26(3):145-152.
• [31]Parasuraman A, Zeithaml VA, Berry LL: A conceptual model of service quality and its implications for future research. J Mark 1985, 49(Fall):41-50.
• [32]Tronto J: Moral Boundaries: A Political Argument for an Ethic of Care. Routledge, London; 1993.
• [33]Sevenhuijsen S: Caring in the third way: the relation between obligation, responsibility and care in Third Way discourse. Critical Social Policy 2000, 20(1):5-37.
• [34]Ferlie E, Geraghty KJ: Professionals in Public Service Organizations: Implications for Public Sector “Reforming”. In Oxford Handbook of Public Management. Edited by Ferlie E, Lynn Jr LE, Pollitt C. Oxford: Oxford University Press; 2005: 422–445.
• [35]Gabbay J, le May A: Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. Br Med J 2004, 329:1013-1017.
• [36]Bate SP, Robert G: Knowledge management and communities of practice in the private sector: Lessons for modernizing the national health service in England and Wales. Public Adm 2002, 80(4):643-663.
• [37]Swart J: HRM and Knowledge Workers. In Oxford Handbook of Human Resource Management. Edited by Boxall P, Purcell J, Wright P. Oxford: Oxford University Press; 2007:450–468.
• [38]Nicolini D, Powell J, Conville P, Martinez-Solano L: Managing knowledge in the healthcare sector: A review. Int J Manag Rev 2008, 10(3):245-264.
• [39]Swinglehurst D, Emmerich N, Maybin J, Park S, Quilligan S: The Many Meanings of ‘Quality’ in Healthcare: Interdisciplinary Perspectives. Cumberland Lodge Colloquium Report 2013. [http://www.cumberlandlodge.ac.uk/Programme/Reports/Quality+in+Healthcare]
• [40]Korczynski M: Human Resource Management in Service Work. Basingstoke, Palgrave; 2002.
• [41]McBride A, Hyde P, Young R, Walshe K: How the “customer” influences the skills of the front line worker. Hum Resour Manag J 2005, 15(2):35-49.
• [42]Swinglehurst D, Emmerich N, Maybin J, Park S, Quilligan S: Rethinking ‘quality’ in health care. Journal of Health Services Research and Policy 2014, 0(0):1–2.
• [43]Cooke H: Seagull management and the control of nursing work. Work Employ Soc 2006, 20(2):223-43.
• [44]Kieft R, de Brouwer B, Francke A, Delnoij D: How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Serv Res 2014, 14:249.
• [45]Maben J, Latter S, Macleod J: The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study. Nurs Inq 2007, 14(2):99-113.
• [46]Francis R: Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive Summary. The Stationery Office, London; 2013.
• [47]Davies HTO, Mannion R: Will prescriptions for cultural change improve the NHS? Br Med J 2013, 346:f1305.
• [48]Donaldson, L. (2005), Speaking at The Health Foundation European Quality Meeting at Danesfield House Hotel, Marlow-on-Thames, Buckinghamshire on Saturday, 26 November 2005. [http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/Archive/CMOAtLarge/Inthespotlight/QuoteUnquote/DH_4102558]
• [49]Charmaz K: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage, London; 2006.
• [50]Henwood K, Pidgeon N: Using Grounded Theory in Psychological Research. In Doing Qualitative Analysis in Psychology. Edited by Hayes N. Hove: Psychology Press; 1997: 245–274.
• [51]Stake R: Qualitative Case Studies. In The Sage Handbook of Qualitative Research 3rd Edition. Edited by Denzin N and Lincoln Y. London: Sage Publications; 2005: 443–466.
• [52]Locke K: Grounded Theory in Management Research. Sage, London; 2001.
• [53]Johnson JM: In-depth interviewing. In Handbook of Interview Research: Context and Methods. Edited by Gubrium, JF, Holstein JA. Thousand Oaks, California: Sage; 2002:103–120.
• [54]Warren CAB: Qualitative Interviewing. In Handbook of Interview Research: Context and Methods. Edited by Gubrium JF and Holstein JA. Sage, London; 2002.
• [55]Armstrong M: Performance Management: Key Strategies and Practical Guidelines. 3rd edition. Kogan Page, London; 2006.
• [56]Bryant A, Charmaz K: The Sage Handbook of Grounded Theory. Sage, London; 2007.
• [57]Strauss AL, Corbin J: Basics of qualitative research: techniques and procedures for developing grounded theory. Sage, Thousand Oaks, California; 1998.
• [58]Evans M: ‘I'm beyond caring’, a response to the Francis Report: the failure of social systems in health care to adequately support nurses and nursing in the clinical care of their patients. Psychoanal Psychother 2014, 28(2):193-210.
• [59]Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G, et al.: Culture and behaviour in the English National Health Service: Overview of lessons from a large multimethod study. BMJ Quality and Safety 2014, 23:106-115.
• [60]Berwick D: A promise to learn – a commitment to act: Improving the Safety of Patients in England. National Advisory Group on the Safety of Patients in England, Crown Copyright; 2013.
• [61]Wenger E: Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press, Cambridge; 1998.
• [62]Kislov R, Walshe K, Harvey G: Managing boundaries in primary care service improvement: A developmental approach to communities of practice. Implement Sci 2012, 7:97.
• [63]Boud D, Cressey P, Docherty P: (Eds): Productive Reflection at Work. Routledge, Oxon; 2006.
• [64]Paley J: Cognition and the compassion deficit: the social psychology of helping behaviour in nursing. Nurs Philos 2014, 15(4):274-287.
• [65]Davies HTO, Mannion R: Will prescriptions for cultural change improve the NHS? Br Med J 2013, 346:f1305.
• [66]Mannion R, Davies HTO, Marshall MN: Cultures for Performance in Health Care. Open University Press, Maidenhead, Berks; 2005.
• [67]Ballatt J, Campling P: Intelligent Kindness. Reforming the Culture of Healthcare. The Royal College of Psychiatrists, London; 2011.
• [68]Olesen V, Bone D: Emotions in rationalizing organizations: conceptual notes from professional nursing in the USA. In Emotions in Social Life: Critical Themes and Contemporary Issues. Edited by Bendelow G, Williams SJ. London: Routledge; 1998: 313–329.
• [69]Bone D: Dilemmas of emotion work in nursing under market-driven health care. International Journal of Public Sector Management 2002, 15(2):140-150.