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Meaning of sustainability of innovations in healthcare organizations: A systematic review. 医疗机构创新可持续性的意义:系统回顾。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-01-29 DOI: 10.1177/09514848231154758
Fernanda de Sousa Gusmão Louredo, Eduardo Raupp, Cláudia Affonso Silva Araujo

Background: There is pressure on healthcare organizations to provide high-quality care to all patients while innovating the way care is delivered. As they take on the challenge of delivering high-quality, innovative services, any gains made tend to stall before a radical change impacts key outcomes given the difficulty in sustaining innovations over time.

Methods: A systematic search was performed in 5 electronic databases using the PRISMA structure that resulted in 1313 articles, of which 260 were duplicated, leaving 1053 articles. After reading their abstracts, 877 had an inadequate scope for analysis because they did not deal with research on the sustainability of innovations. After a full assessment of the remaining 176 articles, only 10 studies met the inclusion criteria with the snowball strategy generating one additional paper, leading to 11 empirical studies. A theoretical discussion and the proposition of a framework were used to analyze the data.

Results: Studies in university hospitals shed light on determining sustainability factors of innovations not yet fully explored such as the meaning given by individuals to innovation, culture, partnerships, and multidisciplinary collaboration, which complement the literature. This research sought to contribute to the dialogue between management theory and practice in studies on the sustainability of health innovations based on experiences observed in university hospitals. Health managers can verify how sustainability relates to the challenges presented and identify a path that helps them overcome the limitations imposed on the process. The literature shows that the understanding of sustainability as a mediating dimension can collaborate in sustained innovations in order to allow managers to identify actions related to the individual-organization dimension that may be compromising the process and thus act in a more efficient, assertive way in determining the factors that sustain ongoing innovations.

Conclusions: A relevant point is that innovation sustainability needs to be an objective to be achieved where managers/individuals must incorporate this perspective of innovation continuity since the beginning of the process, otherwise this may represent a greater propensity for discontinuity. This analysis can potentially be applied in university hospitals, but it can also be applicable to other types of hospitals and public or private institutions as long as it is an organization that adopts, implements, and seeks to sustain innovations in service delivery.

背景:医疗机构面临着为所有患者提供高质量医疗服务的压力,同时还要对提供医疗服务的方式进行创新。当医疗机构面临提供高质量创新服务的挑战时,由于创新难以长期持续,在彻底改变对关键结果产生影响之前,所取得的任何成果往往都会停滞不前:采用 PRISMA 结构在 5 个电子数据库中进行了系统检索,共检索到 1313 篇文章,其中 260 篇重复,剩下 1053 篇。在阅读了这些文章的摘要后,有 877 篇文章因未涉及创新的可持续性研究而无法进行分析。在对剩余的 176 篇文章进行全面评估后,只有 10 项研究符合纳入标准,通过 "滚雪球 "策略又产生了一篇论文,从而得出了 11 项实证研究。对数据的分析采用了理论讨论和提出框架的方法:对大学医院的研究揭示了尚未被充分探讨的决定创新可持续性的因素,如个人赋予创新的意义、文化、伙伴关系和多学科合作,这些都是对文献的补充。本研究试图根据在大学医院观察到的经验,在卫生创新可持续性研究中促进管理理论与实践之间的对话。医疗管理人员可以验证可持续性与所面临的挑战之间的关系,并找出一条有助于他们克服这一过程中的局限性的道路。文献表明,将可持续性理解为一个中介维度,可以在持续创新中进行合作,从而使管理者能够识别与个人-组织维度相关的、可能损害创新进程的行动,从而以更有效、更果断的方式确定维持持续创新的因素:与此相关的一点是,创新的可持续性需要作为一个目标来实现,管理者/个人必须从创新过程的一开始就纳入创新持续性这一视角,否则,这可能代表着更大的不连续性倾向。这项分析可能适用于大学医院,但也适用于其他类型的医院、公共或私营机构,只要该机构在提供服务时采用、实施并寻求持续创新。
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引用次数: 0
Welcome to the home of health management research. 欢迎来到健康管理研究之家。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-12-26 DOI: 10.1177/09514848231225542
Federico Lega
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引用次数: 0
From volume to value: Improving peri-operative elective pathways through a roadmap from fast-track orthopedic surgery. 从数量到价值:通过快速骨科手术的路线图改善围手术期的选择性途径。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2022-09-13 DOI: 10.1177/09514848221127623
Federico Pennestrì, Federico Lega, Giuseppe Banfi

Healthcare institutions face the pressure generated by modern medicine and society, in terms of increasing expectations and financial constraints. Chronic patients need multidisciplinary care pathways to preserve their wellbeing across the entire journey.The orthopaedic community has been particularly receptive in testing solutions to align good clinical outcomes and financial sustainability, given the increase in elective procedures provided among aging populations to alleviate pain and reduce disability. Fast-track (FT) total joint arthroplasty (TJA) and bundled payments (BPs) offer relevant examples both from the clinical and the financial perspective; however, they have not been evaluated in combination yet.The aim of this manuscript is to provide a road map to improve the value of high-volume, multidisciplinary elective procedures, with potential applications in a vast number of surgical specialties, (1) based on an integrated financial budget per episode of care (the BP), (2) building on lessons from a review of the literature on FT TJA.Although clinical outcomes vary from procedure to procedure, the coordination between the single treatments and providers involved across the patient journey; the commitment of patients and relatives; and the systematic adoption of patient-reported outcomes; can add further value for the benefit of patients, healthcare funders and providers, once essential clinical, financial and administrative conditions are guaranteed.

医疗保健机构面临着现代医学和社会带来的压力,包括期望值的增加和资金限制。慢性病患者需要多学科的护理途径,以在整个旅程中保持他们的健康。考虑到老龄化人群中为减轻疼痛和减少残疾而提供的选择性手术的增加,整形外科界特别乐于接受测试解决方案,以将良好的临床结果与财务可持续性相结合。快速通道(FT)全关节置换术(TJA)和捆绑支付(BP)从临床和财务角度提供了相关的例子;然而,它们还没有被综合评估。这份手稿的目的是提供一个路线图,以提高高容量、多学科的选择性手术的价值,并在大量外科专业中具有潜在的应用,(1)基于每一次护理的综合财务预算(BP),(2)基于对FT TJA文献的回顾。尽管不同程序的临床结果各不相同,但在患者旅程中,单一治疗和提供者之间的协调;患者和亲属的承诺;以及系统地采用患者报告的结果;一旦基本的临床、财务和行政条件得到保证,就可以为患者、医疗保健资助者和提供者的利益进一步增加价值。
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引用次数: 0
Reducing waiting times from 65 to under 40 days for children and adolescents receiving mental health services using a new scheduling policy. 利用新的时间安排政策,将接受心理健康服务的儿童和青少年的等待时间从65天减少到40天以下。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2022-08-31 DOI: 10.1177/09514848221122895
Anders N Gullhav, Johan F Skomsvoll, Runa Heimstad, Joseph S Schultz

The aim of this study is to conduct an intervention that tests whether a new scheduling policy designed to reduce waiting times actually will lead to a reduction in waiting times. The new scheduling policy was developed using mixed methods. Qualitative data was gathered to fully understand current planning processes, while quantitative methods were used to model and predict future waiting times. If current planning practices are continued, waiting times will only increase. Additionally, the findings show that simulation modeling can be used to predict the capacity needed for intakes (first appointment) to reduce and maintain target waiting times over time. In our study, this meant a slight increase in capacity for intakes. This new scheduling policy led to a reduction in waiting times from 65 days in 2016, to under 40 days post-intervention in 2017. Waiting times have been held under 40 days since implementation of the new policy, 2017-2020. Our study shows that setting appropriate (weekly) intake goals, will lead to maintaining acceptable levels of variation in waiting times. This theory was tested and proven to be effective.

本研究的目的是进行干预,测试旨在减少等待时间的新调度策略是否真的会减少等待时间。新的调度策略是使用混合方法开发的。收集定性数据以充分了解当前的规划过程,同时使用定量方法对未来的等待时间进行建模和预测。如果继续目前的规划做法,等待时间只会增加。此外,研究结果表明,模拟建模可用于预测招生(首次预约)所需的容量,以减少和保持一段时间内的目标等待时间。在我们的研究中,这意味着摄入量略有增加。这一新的日程安排政策将等待时间从2016年的65天减少到2017年干预后的40天以下。自2017-2020年新政策实施以来,等待时间一直保持在40天以下。我们的研究表明,设定适当的(每周)摄入目标,将使等待时间保持可接受的变化水平。这一理论经过检验并证明是有效的。
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引用次数: 0
The emergence of a value transformation strategic initiative in the healthcare context. 医疗保健背景下价值转型战略举措的出现。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2023-01-11 DOI: 10.1177/09514848231151819
A Erin Bass, Ivana Milosevic, Mary Uhl-Bien, Meagan Millier

How do strategic initiatives emerge? Despite rich tradition in the emergent strategy literature-focused on significant organizational change-surprisingly little insight exists on the dynamics of a new initiative's emergence. This is particularly relevant in healthcare because of the increasing pressure to implement value transformation models focused on maximizing value at the point of care. The value transformation model prioritizes the decisions of the frontline providers and thus requires their expertise and commitment for the model's implementation and success. In our case study of a dental organization, "OptiPlex," we trace the emergence of a value transformation strategic initiative from its origination at the point of care to its formalization into the organization's strategic plan. Using qualitative methods, we identify three phases in the emergence of the value transformation strategic initiative, each embodying different championing behaviors necessary for the initiative's emergence. In doing so, we explicate the nature of these behaviors and how they link up across the organizational hierarchy to drive the value transformation strategic initiative's emergence and implementation.

战略举措是如何产生的?尽管新兴战略文献中有着丰富的传统,专注于重大的组织变革,但令人惊讶的是,对新举措出现的动态却几乎没有什么见解。这在医疗保健中尤其重要,因为实施专注于在护理点实现价值最大化的价值转换模型的压力越来越大。价值转换模式优先考虑一线供应商的决策,因此需要他们的专业知识和承诺来实现该模式并取得成功。在我们对牙科组织“OptiPlex”的案例研究中,我们追溯了价值转型战略举措的出现,从其在护理点的起源到其正式成为组织的战略计划。使用定性方法,我们确定了价值转换战略倡议出现的三个阶段,每个阶段都体现了倡议出现所需的不同支持行为。在这样做的过程中,我们解释了这些行为的性质,以及它们如何在组织层级中联系起来,以推动价值转型战略举措的出现和实施。
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引用次数: 0
Staff perceptions of organisational performance measurement implementation in a health charity. 员工对健康慈善机构实施组织绩效衡量的看法。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2022-10-17 DOI: 10.1177/09514848221134403
Richard William Colbran, Robyn Ramsden, Genevieve Pepin, John W Toumbourou, Karen Stagnitti

The non-acute health charity sector forms part of the global health services industry. Organisational Performance Measurement (OPM) is fundamental for modern business to achieve sustained excellence yet is under-utilised by non-acute health charities. The Non-Acute Health Charity Performance Implementation Framework (NCPI Framework) was developed to support non-acute health charities undertaking OPM. A non-acute health charity case study undertook a 12-month OPM implementation process using the NCPI Framework. This study had three aims. Firstly, to understand the perceptions of staff employed by the case study organisation regarding their experience of the 12-month NCPI Framework implementation process, secondly to identify whether an interrelationship existed between the NCPI Framework's implementation elements and the staff's perspectives, and thirdly, identify areas of strength and improvement which could enhance the NCPI Framework's effectiveness. Data were collected post implementation and analysed thematically from open-ended question responses from an anonymous survey and semi-structured interviews. Participants supported the introduction of OPM and valued the NCPI Framework's structured implementation guidelines. Six interrelated themes were identified: clarity, adaptability, alignment, transparent communication, capability and accountability. Participants suggested adaptations to enhance the NCPI Framework's impact. A culture aligned with organisational learning was identified as potentially having a positive impact on the NCPI Framework's implementation. The NCPI Framework may also have relevance and application to the non-profit industry beyond non-acute health care and for use in program development and service quality initiatives.

非急性健康慈善部门是全球健康服务业的一部分。组织绩效衡量(OPM)是现代企业实现持续卓越的基础,但非急性健康慈善机构却没有充分利用它。非急性健康慈善机构绩效执行框架(NCPI框架)是为了支持非急性健康机构开展门诊管理而制定的。一项非急性健康慈善案例研究使用NCPI框架进行了为期12个月的OPM实施过程。这项研究有三个目的。首先,了解案例研究组织雇用的工作人员对其12个月《全国大会党框架》实施过程的经验的看法,其次,确定《全国大会党框架》的实施要素与工作人员的观点之间是否存在相互关系,第三,确定可以提高NCPI框架有效性的优势和改进领域。数据是在实施后收集的,并根据匿名调查和半结构化访谈的开放式问题回答进行主题分析。与会者支持采用人事管理制度,并重视《全国大会党框架》的结构化实施准则。确定了六个相互关联的主题:明确性、适应性、一致性、透明沟通、能力和问责制。与会者建议进行调整,以增强《国家预防犯罪框架》的影响。与组织学习相一致的文化被认为可能对NCPI框架的实施产生积极影响。NCPI框架还可能与非急性医疗保健以外的非营利行业相关并适用于项目开发和服务质量举措。
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引用次数: 0
Physical therapists' experience using focus on therapeutic outcome in outpatient clinics: A qualitative study. 物理治疗师在门诊使用关注治疗结果的经验:一项定性研究。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2022-08-09 DOI: 10.1177/09514848221118749
Sarbinaz Bekmuratova, Angela Bahle-Lampe, Travis Pflaster

While patient-reported outcomes measures (PROMs) are used in many practice settings as a standardized system of outcome measures, various factors may impact the meaningful use of PROMs by clinicians operating in various settings. Very limited research exists that focused on examining the use of FOTO® in outpatient rehabilitation settings. This study aimed to explore the barriers and facilitators in achieving FOTO® treatment completion rates and patient functional outcomes among physical therapists. Additionally, the study aimed to explore the internal acceptance of FOTO as a useful tool in rehabilitation from the perspectives of physical therapists. Qualitative data were collected through four focus group interviews with physical therapists at outpatient rehabilitation clinics. The interviews were audio-recorded and transcribed, and transcribed, and qualitative content analysis was applied for data analysis. Four major themes emerged from qualitative data analyses including (a) use of FOTO® in clinical practice, (b) reasons why the FOTO® process may not be followed, (c), therapists' perceptions of FOTO®, and (d) perceived barriers and enablers related to FOTO®. The study concluded that multi-level determinants impact the successful use of FOTO® by therapists in outpatient rehabilitation settings. The findings have important implications for clinical practice, organizational leaders, and PROM developers.

虽然患者报告的结果测量(PROM)在许多实践环境中被用作结果测量的标准化系统,但各种因素可能会影响在各种环境中操作的临床医生对PROM的有意义使用。目前的研究非常有限,主要集中在检查FOTO®在门诊康复环境中的使用情况。本研究旨在探索物理治疗师在实现FOTO®治疗完成率和患者功能结果方面的障碍和促进因素。此外,本研究旨在从物理治疗师的角度探讨FOTO作为康复有用工具的内部接受度。定性数据是通过对门诊康复诊所物理治疗师的四次焦点小组访谈收集的。访谈被录音、转录和转录,定性内容分析被应用于数据分析。定性数据分析得出了四个主要主题,包括(a)在临床实践中使用FOTO®,(b)可能不遵循FOTO®流程的原因,(c)治疗师对FOTO®的看法,以及(d)与FOTO®相关的障碍和促成因素。该研究得出结论,多层次的决定因素影响治疗师在门诊康复环境中成功使用FOTO®。研究结果对临床实践、组织领导和PROM开发人员具有重要意义。
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引用次数: 1
Predictors of international Muslim medical tourists' expectations on halal-friendly healthcare services: A hospital-based study. 国际穆斯林医疗游客对清真医疗服务期望的预测因素:一项基于医院的研究。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-11-01 Epub Date: 2022-06-17 DOI: 10.1177/09514848221109831
Mohsen Naserirad, Mohamad Tavakol, Mahmoud Abbasi, Behrooz Jannat, Naficeh Sadeghi, Zahra Bahemmat

Background: Halal-friendly healthcare services have emerged as an important sector of the overall healthcare service delivery system. This study aimed to examine levels and determinants of expectations on halal-friendly healthcare services from the Muslim medical tourists' perspective.

Methods: A cross-sectional survey was conducted in four cities, seventeen hospitals, across Iran, with a sample of 365 international Muslim medical tourists.

Results: Mean expectation score of the respondents was 3.95 ± 1.43. Being in the 25-34 age group (aOR = 2.65; CI 95%: 2.14-3.16), being married (aOR = 2.09; CI 95%: 1.46-2.72), having completed secondary education (aOR = 2.14; CI 95%: 1.26-3.02), belonging to a high-income socioeconomic background (aOR = 1.69; CI 95%: 1.06-2.33), coming from Iraq (aOR = 3.08; CI 95%: 2.12-4.04), being Shia (aOR = 2.83; CI 95%: 2.00-3.67), receiving information by recommendation as a source for travel decision (aOR = 3.02; CI 95%: 1.82-4.22), traveling with family or relatives (aOR=2.16; CI 95%: 1.42-2.90), receiving medical service of cosmetic surgery (aOR = 1.57; CI 95%: 1.22-1.92) and cardiovascular therapy (aOR = 2.33; CI 95%: 1.23-3.43), and traveling one or two times in the past (aOR = 2.33; CI 95%: 1.00-3.66) significantly increased the expectations on halal-friendly healthcare services.

Conclusion: This study will represent an important contribution to the literature concerned with the levels and drivers of expectations on halal-friendly healthcare services.

背景:清真医疗服务已成为整个医疗服务提供系统的一个重要部门。本研究旨在从穆斯林医疗游客的角度考察对清真友好医疗服务的期望水平和决定因素。方法:以365名国际穆斯林医疗游客为样本,在伊朗全国四个城市、十七家医院进行横断面调查。结果:调查对象的平均期望得分为3.95±1.43。25-34岁年龄组(aOR=2.65;置信区间95%CI:2.14-3.16),已婚(aOR=2.09;置信区间95:1.46-2.72),已完成中等教育(aOR=1.14;置信区间95%:1.26-3.02),属于高收入社会经济背景(aOR=1.69;置信区间95.1.06-2.33),来自伊拉克(aOR=3.08;置信度95%:2.12-4.04),什叶派(aOR=0.83;置信区间95/2.00-3.67),通过推荐获得信息作为旅行决策的来源(aOR=3.02;置信区间95%:1.82-4.22),与家人或亲戚一起旅行(aOR=2.16;置信区间95%CI:1.42-2.90),接受美容手术医疗服务(aOR=1.57;置信区间95%:1.22-1.92)和心血管治疗(aOR=2.33;置信区间95.1.23-3.43),过去旅行过一到两次(aOR=2.33;CI 95%CI:1.00-3.66)显著增加了对清真友好医疗服务的期望。结论:这项研究将对有关清真友好医疗服务期望水平和驱动因素的文献做出重要贡献。
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引用次数: 3
The implementation of a precision case management model in a Canadian inpatient rehabilitation center: The 12-months post-implementation findings of a quality improvement project. 精准病例管理模式在加拿大住院康复中心的实施:质量改进项目实施后12个月的结果。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-08-01 DOI: 10.1177/09514848221109832
Michael Chislett, Karen Hurtubise, Jason McCarthy, Cathy Hoyles

Despite recommendations, few have reported on quality improvement initiatives to implement length of rehabilitation stay benchmarks, while actively monitoring functional outcomes. This article describes the development, implementation, and evaluation of a precision case management model across all inpatient rehabilitation client groups in a Canadian facility. To develop the length of rehabilitation-stay (LoRS) benchmarks, patient data was retrospectively analyzed. A severity specific method was used to stratify median length of stay. A target reduction on 8.6 days in LoRS was established. Functional discharge targets were also set and monitored at specific intervals via the Functional Independence Measure (FIM®). The implementation used an incremental quality improvement phased approach. Following 12-months, a statistically significant reduction in mean LoRS of 13.2 days was achieved, along with a small increase in FIM® change across all rehabilitation client groups. A similar pattern was seen across the three main client groups, where a LoRS reduction greater than the target was achieved, along with important improvements in LoRS efficiency. This study demonstrates how the implementation of a precision case management model can assist a facility in markedly reducing LoRS across inpatient groups, without compromising functional change or community discharge rates and begin its transformation to a value-based organization.

尽管有这些建议,但在积极监测功能结果的同时,很少有关于实施康复住院时间基准的质量改进倡议的报道。本文描述了在加拿大一家机构的所有住院康复客户群体中精确病例管理模型的开发、实施和评估。为了制定康复停留时间(LoRS)基准,对患者数据进行回顾性分析。采用严重程度特异性方法对中位住院时间进行分层。目标是减少8.6天的LoRS。通过功能独立性测量(FIM®)设定和监测功能放电目标。实现使用了一种渐进式质量改进分阶段方法。12个月后,在所有康复客户组中,平均LoRS减少了13.2天,具有统计学意义,FIM®变化也有小幅增加。在三个主要客户组中也看到了类似的模式,在这些客户组中,LoRS的减少幅度超过了目标,同时LoRS的效率也得到了重要提高。本研究展示了精确病例管理模型的实施如何帮助机构在不影响功能变化或社区出院率的情况下显著减少住院患者群体的LoRS,并开始向基于价值的组织转型。
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引用次数: 0
When caring breeds contempt: The impact of moral emotions on healthcare professionals' commitment during a pandemic. 当关怀滋生轻蔑:大流行期间道德情绪对医护人员承诺的影响。
IF 2.1 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-08-01 DOI: 10.1177/09514848231165894
Morgan Davidson, Meena Andiappan

The novel coronavirus (COVID-19) pandemic is a major heath crisis that continues to impact healthcare organizations worldwide. As infection rates surged, there was a global shortage of personal protective equipment, critical medications, ventilators, and hospital beds, meaning that healthcare professionals faced increasingly difficult workplace conditions. In this conceptual study, we argue these situations can lead to healthcare professionals experiencing moral emotions - defined as specific emotions which relate, or occur in response, to the interest or welfare of others - towards their organizations. This paper explores the three moral emotions of contempt, anger and disgust, and their potential influence on healthcare professionals' workplace commitment in the context of a pandemic. Drawing from the moral emotions and organizational commitment literature, we develop a process model to demonstrate how healthcare professionals' affective and continuous commitment are likely to decrease while, paradoxically, normative, and professional commitment may become amplified. The possible potential for positive outcomes from negative moral emotions is discussed, followed by theoretical and practical contributions of the model, and finally, directions for future research.

新型冠状病毒(COVID-19)大流行是一场持续影响全球医疗保健组织的重大健康危机。随着感染率飙升,全球个人防护装备、关键药物、呼吸机和病床短缺,这意味着医疗保健专业人员面临越来越困难的工作条件。在这一概念性研究中,我们认为这些情况可能导致医疗保健专业人员体验道德情绪-定义为与他人的利益或福利相关或在响应中发生的特定情绪-对其组织。本文探讨了轻视、愤怒和厌恶这三种道德情绪,以及它们在大流行背景下对医护人员工作场所承诺的潜在影响。从道德情绪和组织承诺文献中,我们开发了一个过程模型来证明医疗保健专业人员的情感和持续承诺如何可能减少,而矛盾的是,规范和专业承诺可能会被放大。讨论了消极道德情绪可能产生的积极结果,然后讨论了该模型的理论和实践贡献,最后讨论了未来的研究方向。
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引用次数: 0
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Health Services Management Research
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