运用PDCA循环理论提升医院护理质量管理的研究
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摘要
研究背景
随着我国经济的不断发展和人民生活水平的逐步提高,人们开始追求更高的生活质量。因此,对于与生活质量密切相关的医疗质量而言,人们的要求也在快速提高。目前,我国的医疗机构数和总诊疗人次迅速增长。根据卫生部统计,至2006年底我国共有县级及县级以上医院19246家,较1999年增长了32%;2006年总诊疗人次达24.46亿,而1997-2001年间,我国医院总诊疗人次仅在13亿人次/年上下波动。随着医疗服务的迅速增加,医疗纠纷的发生率也快速上升,医患关系急剧恶化,究其深层次原因,绝大部分与医疗质量相关。而在发达国家如美国每年平均也有44000-98000名患者死于医疗护理差错,可见医疗护理质量改进任重道远。护理作为医院的关键子系统,其质量高低直接影响着医院的兴衰。但护理质量的高低不仅取决于护理人员的素质,更直接依赖于护理质量管理的方法。目前,我国医院普遍存在护理管理人员的管理观念还比较落后,在知识结构上,她们往往是专业知识含量远大于管理知识含量,管理的实践大都以传统型、经验型为主,如何运用科学的理论提高护理质量,提高病人的满意度,是近几年护理管理者们一直思考和努力解决的问题。在2005—2010年的中国护理事业发展规划纲要中也明确提出护理管理的科学化水平需要提高,要对我国护理管理者进行上岗培训并寻求标准化的管理模式。卫生部亦将它列为一项重要研究课题。
PDCA循环理论作为开展质量管理活动的一种科学工作程序,现已广泛应用于各个领域并卓有成效,也日益受到了护理管理者们的关注和重视。近几年,国外在护理质量管理工作中应用PDCA循环已趋成熟,较好地提高了护理质量。随着该理念在我国护理领域的不断渗透,国内已有护理研究者将此理论运用于如病历书写、技术操作培训等部分护理质量的管理中,并取得了一定的成效,但大多属于经验总结,缺乏实验性的研究设计。总之,对于将PDCA循环运用于全面的护理质量管理中,形成完整的运用体系,尚未起步。因此本课题遵循TQM理念,与时俱进地开展了PDCA循环理论在护理质量标准化管理中运用的研究。期望能进一步提升医院护理质量,减少医患冲突,构建和谐社会。
研究目的
在台州市第一人民医院进行了实证研究,探索PDCA循环在护理质量管理中的运用方法,以寻求科学、有效的适合我国国情的护理质量管理方法,以较快提高护理内涵质量,从而提升医院医疗质量,减少医患冲突,构建和谐社会。
研究方法
通过开展理论研究,并在大量文献检索和临床资料收集的基础上,结合临床调研、专家会议等方法,研究PDCA循环理论在医院护理质量管理中的运用流程。并以浙江省综合性医院评审标准(三级医院)之护理质量评审指标为管理标准,选择在台州市第一人民医院护理质量管理中运用PDCA循环。严格按照PDCA循环的四个阶段八个步骤实施该护理质量管理标准。即:四个阶段:计划(Plan)、执行(Do)、检查(Cheek)、处理(Act);八个步骤:分析现状找出问题、分析各种影响因素、找出主要因素、采取措施制定计划、执行制定的措施计划、检查结果、标准化处理、遗留下来的问题转入下一个PDCA循环。通过RSR(秩和比)法评价流程运用前后护理质量的变化。
研究结果
1、医院护理质量管理的调查结果
2、PDCA循环理论在医院护理质量管理中的运用流程;
3、流程运用前后的护理质量评价;
六个观察指标值即病人满意度、基础护理、专科护理、技术操作、病历书写、病房管理及管理制度质量均呈逐年上升;
对二年的护理质量进行了RSR法分析,拟合线性回归方程为:RSR=-0.582+0.22×Y;
护理质量归档结果:根据RSR和Y值分布,综合护理质量随时间的推移,依次上升为合格、良、优三个等级;
研究结论
通过理论研究和对护理质量的调查,创建了PDCA循环理论在医院护理质量管理中的运用流程:实证研究证明PDCA循环的导入提高了病人及护士的满意度,形成了质量管理的良性循环体系,提高了护理人员的管理素质,使护理质量得到了持续提高。在护理质量管理中运用PDCA循环理论,能较快提高护理内涵质量,从而达到提升医院医疗质量,减少医患冲突,构建和谐社会的目的。
Background
With the development of Chinese economy, the living standards of Chinese people improve gradually, people began to seek a higher quality of life. As the quality of life is closely related to the quality of health care, The requirements of health care also increased rapidly. According to the statistics of Ministry of healthy, by the end of 2006, hospital of county and above in China was 19,246, increased by 32% comparing with the data collected in 1999. In 2006, a total of medical behavior was 2.446 billion and during 1997-2001, was 1.3 billion per year. With the rapid increase of medical services, the incidence of medical disputes of medical quality is growing rapidly. Even in developed countries such as the United States, there are 44000-98000 patients average per year died of health care errors, we can see that there is a long way to improve the medical quality. Nursing quality is the critical factor of health care quality management. At present, the management ability of nursing administrators is still relatively lower, most of them lack management skill comparing with professional capability. Therefore, there is a long way to go to promote nursing quality and patient satisfaction in the near future. PDCA cycle theory is a scientific work procedures widely used in management of quality. In recent years, the application of PDCA cycle in nursing quality in foreign countries is mature. With the concept penetration, domestic nurse researchers have applied this theory in the area of medical writing、technical operations and the training of nurse, Some has achieved some results, but most of them belongs to experience, lacking of experimental research design. In short, the PDCA cycle used for total nursing quality management, has not yet started. This paper, by employing the TQM concept, and PDCA cycle theory in the nursing quality management, tries to improve the nursing quality, reduce patient conflict and build a harmonious society.
Objectives
To seek out a scientific and effective method to improve the nursing quality of hospital, the empirical study of applying PDCA cycle in the nursing quality management was held in the First People' s Hospital of Taizhou . The purpose is to reduce patient conflict and build a harmonious society.
Methods
Through document retrieval and clinical research, expert meetings, we introduce PDCA cycle theory into the nursing quality management, and adopt the Zhejiang Province hospital accreditation standards. An empirical study carrying out the PDCA cycle on the nursing quality management of the First People' s Hospital of Taizhou was made according to RSR (RSR ratio) method to evaluate the changes of the nursing quality.
Results
1 The findings of nursing hospital quality management.
2 The procedure of PDCA cycle theory applying in the nursing quality management;
3 The evaluation of the nursing quality before and after the process applied;
Six observation that the foundation nursing ,specialty nursing ,nursing technique, nursing record , ward management and management system and patient's satisfaction showed increased year by year;
On the quality of nursing for the RSR method of fitting linear regression equation: RSR =- 0.582 +0.22×Y;
Quality of nursing archiving Results: According to the distributionof RSR and Y comprehensive quality care with the passage of time, followedby increased qualified、good、excellent three grades.
Conclusion
Through document retrieval and clinical research, expert meetings, theoretical research, we set up the procedure of PDCA cycle theory in the nursing quality management. Empirical studies have proved it can improve patient and nurses satisfaction, and the diathesis of nursing staff as well .By the virtuous cycle of quality management, the quality of nursing is being continuing improving. It can reduce patient conflict and build a harmonious society with the apply of PDCA cycle.
随着我国经济的不断发展和人民生活水平的逐步提高,人们开始追求更高的生活质量。因此,对于与生活质量密切相关的医疗质量而言,人们的要求也在快速提高。目前,我国的医疗机构数和总诊疗人次迅速增长。根据卫生部统计,至2006年底我国共有县级及县级以上医院19246家,较1999年增长了32%;2006年总诊疗人次达24.46亿,而1997-2001年间,我国医院总诊疗人次仅在13亿人次/年上下波动。随着医疗服务的迅速增加,医疗纠纷的发生率也快速上升,医患关系急剧恶化,究其深层次原因,绝大部分与医疗质量相关。而在发达国家如美国每年平均也有44000-98000名患者死于医疗护理差错,可见医疗护理质量改进任重道远。护理作为医院的关键子系统,其质量高低直接影响着医院的兴衰。但护理质量的高低不仅取决于护理人员的素质,更直接依赖于护理质量管理的方法。目前,我国医院普遍存在护理管理人员的管理观念还比较落后,在知识结构上,她们往往是专业知识含量远大于管理知识含量,管理的实践大都以传统型、经验型为主,如何运用科学的理论提高护理质量,提高病人的满意度,是近几年护理管理者们一直思考和努力解决的问题。在2005—2010年的中国护理事业发展规划纲要中也明确提出护理管理的科学化水平需要提高,要对我国护理管理者进行上岗培训并寻求标准化的管理模式。卫生部亦将它列为一项重要研究课题。
PDCA循环理论作为开展质量管理活动的一种科学工作程序,现已广泛应用于各个领域并卓有成效,也日益受到了护理管理者们的关注和重视。近几年,国外在护理质量管理工作中应用PDCA循环已趋成熟,较好地提高了护理质量。随着该理念在我国护理领域的不断渗透,国内已有护理研究者将此理论运用于如病历书写、技术操作培训等部分护理质量的管理中,并取得了一定的成效,但大多属于经验总结,缺乏实验性的研究设计。总之,对于将PDCA循环运用于全面的护理质量管理中,形成完整的运用体系,尚未起步。因此本课题遵循TQM理念,与时俱进地开展了PDCA循环理论在护理质量标准化管理中运用的研究。期望能进一步提升医院护理质量,减少医患冲突,构建和谐社会。
研究目的
在台州市第一人民医院进行了实证研究,探索PDCA循环在护理质量管理中的运用方法,以寻求科学、有效的适合我国国情的护理质量管理方法,以较快提高护理内涵质量,从而提升医院医疗质量,减少医患冲突,构建和谐社会。
研究方法
通过开展理论研究,并在大量文献检索和临床资料收集的基础上,结合临床调研、专家会议等方法,研究PDCA循环理论在医院护理质量管理中的运用流程。并以浙江省综合性医院评审标准(三级医院)之护理质量评审指标为管理标准,选择在台州市第一人民医院护理质量管理中运用PDCA循环。严格按照PDCA循环的四个阶段八个步骤实施该护理质量管理标准。即:四个阶段:计划(Plan)、执行(Do)、检查(Cheek)、处理(Act);八个步骤:分析现状找出问题、分析各种影响因素、找出主要因素、采取措施制定计划、执行制定的措施计划、检查结果、标准化处理、遗留下来的问题转入下一个PDCA循环。通过RSR(秩和比)法评价流程运用前后护理质量的变化。
研究结果
1、医院护理质量管理的调查结果
2、PDCA循环理论在医院护理质量管理中的运用流程;
3、流程运用前后的护理质量评价;
六个观察指标值即病人满意度、基础护理、专科护理、技术操作、病历书写、病房管理及管理制度质量均呈逐年上升;
对二年的护理质量进行了RSR法分析,拟合线性回归方程为:RSR=-0.582+0.22×Y;
护理质量归档结果:根据RSR和Y值分布,综合护理质量随时间的推移,依次上升为合格、良、优三个等级;
研究结论
通过理论研究和对护理质量的调查,创建了PDCA循环理论在医院护理质量管理中的运用流程:实证研究证明PDCA循环的导入提高了病人及护士的满意度,形成了质量管理的良性循环体系,提高了护理人员的管理素质,使护理质量得到了持续提高。在护理质量管理中运用PDCA循环理论,能较快提高护理内涵质量,从而达到提升医院医疗质量,减少医患冲突,构建和谐社会的目的。
Background
With the development of Chinese economy, the living standards of Chinese people improve gradually, people began to seek a higher quality of life. As the quality of life is closely related to the quality of health care, The requirements of health care also increased rapidly. According to the statistics of Ministry of healthy, by the end of 2006, hospital of county and above in China was 19,246, increased by 32% comparing with the data collected in 1999. In 2006, a total of medical behavior was 2.446 billion and during 1997-2001, was 1.3 billion per year. With the rapid increase of medical services, the incidence of medical disputes of medical quality is growing rapidly. Even in developed countries such as the United States, there are 44000-98000 patients average per year died of health care errors, we can see that there is a long way to improve the medical quality. Nursing quality is the critical factor of health care quality management. At present, the management ability of nursing administrators is still relatively lower, most of them lack management skill comparing with professional capability. Therefore, there is a long way to go to promote nursing quality and patient satisfaction in the near future. PDCA cycle theory is a scientific work procedures widely used in management of quality. In recent years, the application of PDCA cycle in nursing quality in foreign countries is mature. With the concept penetration, domestic nurse researchers have applied this theory in the area of medical writing、technical operations and the training of nurse, Some has achieved some results, but most of them belongs to experience, lacking of experimental research design. In short, the PDCA cycle used for total nursing quality management, has not yet started. This paper, by employing the TQM concept, and PDCA cycle theory in the nursing quality management, tries to improve the nursing quality, reduce patient conflict and build a harmonious society.
Objectives
To seek out a scientific and effective method to improve the nursing quality of hospital, the empirical study of applying PDCA cycle in the nursing quality management was held in the First People' s Hospital of Taizhou . The purpose is to reduce patient conflict and build a harmonious society.
Methods
Through document retrieval and clinical research, expert meetings, we introduce PDCA cycle theory into the nursing quality management, and adopt the Zhejiang Province hospital accreditation standards. An empirical study carrying out the PDCA cycle on the nursing quality management of the First People' s Hospital of Taizhou was made according to RSR (RSR ratio) method to evaluate the changes of the nursing quality.
Results
1 The findings of nursing hospital quality management.
2 The procedure of PDCA cycle theory applying in the nursing quality management;
3 The evaluation of the nursing quality before and after the process applied;
Six observation that the foundation nursing ,specialty nursing ,nursing technique, nursing record , ward management and management system and patient's satisfaction showed increased year by year;
On the quality of nursing for the RSR method of fitting linear regression equation: RSR =- 0.582 +0.22×Y;
Quality of nursing archiving Results: According to the distributionof RSR and Y comprehensive quality care with the passage of time, followedby increased qualified、good、excellent three grades.
Conclusion
Through document retrieval and clinical research, expert meetings, theoretical research, we set up the procedure of PDCA cycle theory in the nursing quality management. Empirical studies have proved it can improve patient and nurses satisfaction, and the diathesis of nursing staff as well .By the virtuous cycle of quality management, the quality of nursing is being continuing improving. It can reduce patient conflict and build a harmonious society with the apply of PDCA cycle.
引文
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[8]Redick EL,Applying FOCUS-PDCA to solve clinical problems.Dimens Crit Care Nurs.1999 Nov-Dec;18(6):30-4.
[9]Miano B,Wood W.Implementation of the i.v.push method of antibiotic administration using the FOCUS/PDCA approach.Home Healthc Nurse.1998Dec;16(12):831-7.
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[14]彭梅琼,吕湘莲,干永珍.运用PDCA循环,提高护理记录质量[J]护理实践与研究.2006,3(2):53-54
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[18]白霞,王美灵,贾雪艳.PDCA循环在心血管外科ICU护理中的的应用[J].护理实践与研究.2005,2(3):12-13
[19]周雪芬.运用PDCA循环法提高门诊护理安全管理[J].中国实用护理杂志2005,21(10):67-68
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[22]王卫红,刘 宝,李 娅.应用PDCA循环预防导尿引起泌尿道感染[J].中华医院感染学杂志,2001,11(4):269-270.
[23]王小林.PDCA法在病区护理人力资源管理中应用[J].齐鲁护理杂志,2002,8(1):78-79.
[24]高彩虹,王 伟,邢桂玲./PDCA管理环0应用于护士长队伍建设的尝试[J].实用护理杂志,2000,16(11):46.
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[35](美)威廉.詹姆斯(William James)著,田平译.心理学原理.北京:中国城市出版社,2003
[1]谢家驹.全面优质管理.上海:上海财经大学出版社,1999:3-4
[2]刘源张.质量管理和质量保证系列国家标准.北京:中国标准出版社,1993:6-7
[3]朱敖荣,戴志澄,毛 磊.管理学基础[M].长春:吉林人民出版社,1994.479.
[4]Joint Commmission.An Introduction to the Joint Commmission Nursing Care Standards.Chicago:Joint Commmission,1990.49-62
[5]张春肪,任景坤.实用护理质量管理与护理记录书写小范.北京海军出版社.2003.1
[6]左月燃.医院护理质量管理及评估体系建设[J].国外医学护理学分册,2004,23(6):287-291
[7]王爱华,孙凤英.护理质量管理方法研究及发展预测[J].中国护理管理,2004,4(3):38-391
[8]李亚洁,王丽姿,王秀岚.ISO9000族标准八项质量管理原则在护理中的应用.中华护理杂志,2001,36(12):916-918.
[9]Faxon DP,Schwamm LH,PasLernak RC,et.al.Improving qualily of care through disease management:principles and recommendations from the American Heart Association' s Expert Panel on Disease Management.Circulation,2004,109(21):2651-2654.
[10]Guyatt G,Meade M.Jaschke R,etal.Practitioners of evidence based care.BMJ,2000,320:954-955.
[11]Berwick DM.Continuous improvements as an ideal in health care.N Engl J Med,1989,320(21):53-56.
[12]Redick EL,Applying FOCUS-PDCA to solve clinical problems.Dimens Crit Care Nurs.1999 Nov-Dec;18(6):30-4.
[13]Miano B,Wood W.Implementation of the i.v.push method of antibiotic administration using the FOCUS/PDCA approach.Home Healthc Nurse.1998Dec;16(12):831-7.
[14]Provance L,Alvis D,Silfen E.Quality improvement and public health-tetanus immunization in the emergency department.Am J Med Qual.1994Winter;9(4):165-71.
[15]Velletri J,Boyle K.Beating the mandatory blues:using the FOCUS PDCA process.Nurs Staff Dev Insid.1998 May-Jun;5(3):19-20.
[16]侯秀欣,刘皎.运用PDCA循环提高护理病历书写质量分析[J]实用中医内科杂志.2006,20(1):105
[17]王虹,丁永艳,甘孝红.PDCA循环在护理记录书写质量管理中的应用[J]护理学报.2006,13(3):88-89
[18]彭梅琼,吕湘莲,干永珍.运用PDCA循环,提高护理记录质量[J]护理实践与研究.2006,3(2):53-54
[19]郭炀,谭进.PDCA循环护理技能操作中的应用[J].湘南学院学报(医学版).2006,8(3):77-78
[20]高玉霞,张秀英,张巍等.技能训练中运用PDCA循环培养护生自我管理能力[J].护理研究.2006,20(10):2621-2622
[21]吴玉玲,寇丽霞.李秋宇等.运用PDCA循环法培训新护士静脉穿刺技术[J].海南医学院学报.2005,11(3):223-224
[22]白霞,王美灵,贾雪艳.PDCA循环在心血管外科ICU护理中的的应用[J].护理实践与研究.2005,2(3):12-13
[23]周雪芬.运用PDCA循环法提高门诊护理安全管理[J].中国实用护理杂志2005,21(10):67-68
[24]段秀兰,唐松梅,喻英等.应用PDCA循环控制下肢动脉硬化闭塞症危险因素的研究[J].护理研究.2006,20(10):2673-2675
[25]楼士梅,杨丽琴,郭小红.PDCA循环管理法在糖尿病健康教育中的应用[J].实用中西医结合临床.2005,5(4):85-86
[26]王卫红,刘 宝,李 娅.应用PDCA循环预防导尿引起泌尿道感染[J].中华医院感染学杂志,2001,11(4):269-270.
[27]王小林.PDCA法在病区护理人力资源管理中应用[J].齐鲁护理杂志,2002,8(1):78-79.
[28]高彩虹,王伟,邢桂玲./PDCA管理环0应用于护士长队伍建设的尝试[J].实用护理杂志,2000,16(11):46.
[29]陈颉.质量管理宗师,企业管理.2004:7:78
[30]施雁,护理质量实效性研究.中华护理杂志,2006,41(5):443-444
[31]姚智萍,杨慧群.住院病人护理需求调查分析及对策,中国农村卫生事业管理杂志2006,26(6):51