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• W2433958456 abstract "The aims of this study were to assess the level of implementation of continuous quality management program and to identify the factors associated with its failure in the medical departments of a teaching hospital.Semi-directive interviews were conducted with 52 hospitalists, including 16 department heads and 36 staff members in charge of quality management, in 30 medical departments that implemented a continuous quality management program from 1998 to 2002. The interviews were analyzed using a manual thematic method and a computerized semantic method.At the study endpoint (i.e., 2003), the continuous quality management program was still working in six departments and was stopped in 24 departments. The professionals complied with the model of intervention based on the identification and the resolution of department problems by multiprofessional working groups. The main external factors associated with the failure of the continuous quality management program included shortage in staff and the lack of time to devote to this activity. In addition, professionals cited the defect of commitment by the top management, the lack of acknowledgment of their efforts, and the hospital accreditation as factors with negative impact on staff motivation.The main internal factors associated with the failure of the continuous quality management program were related to the leadership in quality management. The personal involvement of the department head played a key role in the continuation of the quality management program. Most of the staff regretted the lack of involvement of the physicians and stated that methodological support was needed.The implementation of quality management in the medical departments remains difficult in the absence of institutional support. The leadership within the department plays a major role in the continuation of the process.L’objectif de l’étude était d’évaluer un programme d’implantation de la gestion de la qualité dans les services médicaux d’un hôpital universitaire et d’identifier les facteurs de pérennisation de la gestion de la qualité dans les services.L’étude concernait les 30 services médicaux du CHU qui ont intégré le programme de 1998 à 2002. Des entretiens semi-directifs ont été proposés aux chefs de services et aux responsables qualité des services. Les entretiens ont concernés 52 personnes. Ils ont fait l’objet d’une analyse thématique manuelle et d’une analyse sémantique automatisée.À la date de point, soit cinq ans après le début du programme, six structures avaient une démarche qualité active et 24 déclaraient avoir interrompu cette activité. Les professionnels ont adhéré au modèle d’intervention fondé sur l’identification et la résolution de problèmes du service par des groupes de travail multiprofessionnels. Les difficultés extérieures aux services étaient dominées par le manque de ressources humaines et le manque de temps à consacrer à la démarche qualité. Le défaut d’engagement de la direction, l’absence de reconnaissance de leurs efforts et l’accréditation de l’établissement ont eu un effet négatif sur la motivation des équipes. Les principaux facteurs internes aux services étaient liés au leadership de démarche. L’implication personnelle du chef de service jouait un rôle important dans la pérennité des démarches qualité. La plupart des acteurs regrettaient le défaut d’implication des médecins et affirmaient avoir besoin d’un soutien méthodologique.L’implantation de la gestion de la qualité dans les services médicaux reste difficile en absence de soutien institutionnel. Le leadership au sein des services joue un rôle majeur dans la pérennité de la démarche." @default.
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• W2433958456 date "1993-02-01" @default.
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• W2433958456 title "Accelerators and Inhibitors to Organizational Change in a Hospital" @default.
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• W2433958456 doi "https://doi.org/10.1016/s0097-5990(16)30588-7" @default.
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