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Evaluering af en geriatrisk funktion på et mellemstort dansk hospital
Nordic Council of Ministers, Nordic School of Public Health NHV.
2007 (Danish)Independent thesis Advanced level (degree of Master (Two Years))Student thesisAlternative title
An evaluation of a geriatric ward in a medium sized Danish hospital (English)
Abstract [da]

Introduktion: De nordiske hospitaler er i disse år præget af talrige organisationsændringer. Evalueringer heraf foregår traditionelt kvantitativt. Der er ikke tradition for at anvende kvalitative metoder. Patientperspektivet undersøges i Danmark kvantitativt gennem årlige patienttilfredsheds-undersøgelser, men resultaterne her af kan ikke ses i sammenhæng med en given aktivitet på et givent sengeafsnit. Medarbejderperspektivet medtages slet ikke i forbindelse med evalueringer af organisatoriske ændringer i sundhedsvæsenet.

Formål: Formålet med denne evaluering er at undersøge sammenhænge mellem den konkrete målopfyldelse på udvalgte kvalitetsindikatorer, medarbejdernes oplevelser af og syn på at arbejde på det geriatriske sengeafsnit samt de pårørende og patienternes oplevelser under indlæggelsen.

 Det er hensigten at tegne et så nuanceret billede som muligt af det geriatriske sengeafsnit og at få afdækket såvel hensigtsmæssige som uhensigtsmæssige forhold i medarbejdernes arbejdsliv og i patienternes oplevelse af indlæggelsen.

Metode: Andel af opfyldte kvalitetsindikatorer måles ved auditgennemgang af 50 konsekutivt udvalgte patientjournaler fra indlæggelser på det geriatriske sengeafsnit. Patient- og pårørendeperspektivet belyses gennem 4 interviews i umiddelbar tilslutning til patienternes udskrivelse og Medarbejderperspektivet undersøges gennem to individuelle interviews med lederne af afsnittet og et fokusgruppeinterview med otte medarbejdere fra det geriatriske sengeafsnit.

De kvantitative data fremstilles i tabelform og de kvalitative data indholdsanalyseres og fremstilles i citatform. De indbyrdes sammenhænge mellem de bearbejdede data undersøges og fremstilles.

Resultater: Medarbejderne udtrykker frustration og mangel på ledelse. De har svært ved at se sammenhæng i hverdagens aktiviteter og oplever mangel på ro og meningsfuldhed i dagligdagen. De finder ikke de kliniske kvalitetsindikatorer relevante for deres arbejde.

Der er lav andel af opfyldte kliniske kvalitetsindikatorer. Dette understøttes af patienterne og de pårørendes oplevelser under indlæggelsen og det forklares til en vis grad af medarbejdernes opfattelse af nødvendigheden af at opfylde de forventede krav og i særlig grad af medarbejdernes oplevelse af mangel på ledelse, sammenhæng og meningsfuldhed.

Konklusion: Der findes konsistent sammenhæng mellem de tre perspektiver. Medarbejderperspektivet beskriver årsagsforklaringer til den lave andel af opfyldte kliniske kvalitetsindikatorer og patient- og pårørendeperspektivet peger på konsekvenserne af samme.

Metodetrianguleringen til evaluering af en organisationsændring har dermed vist sig hensigtsmæssig til at forstå baggrund og sammenhænge i resultatet af en organisationsændring i højere grad end de traditionelle evalueringsmetoder.

Abstract [en]

Introduction:  The Nordic Hospitals have these years seem a lot of organizational changes.

They are traditionally quantitatively evaluated. There is no tradition to use qualitative evaluation methods. The perspective of the patients is examined quantitatively by a patient satisfaction survey each year, but it is not possible to see the results of these surveys in coherence to a given activity in a given ward in the hospital. The perspective of the employees is not included in evaluations of organizational changes.

Purpose: The purpose of this evaluation is to examine coherence between the indicators that have been fulfilled, and the employees’ experience of their daily work, together with the patients – and their relatives’ experience of the admittance at the ward. 

It is the intention to show a picture as varied as possible of the geriatric ward and both reasonable and not reasonable conditions in the employees work life and in the patients’ experiences.

 Method: The clinical indicators of quality are examined by an audit reading of 50 consecutively chosen patient files from the geriatric ward. The patients – and the relatives perspective is illuminated by four interviews with patients and relatives directly following their admittance to the ward and the perspective of the employees is illuminated by two interviews with the managers of the ward and a focus group interview with eight staff members of the ward.

Results: The employees express frustration and lack of management. It is not easy for them to see coherence in the daily activities and they experience absence of peace and meaning in their daily work. In their opinion, the clinical indicators of quality are not relevant for their work.

Only a low part of the indicators of clinical quality fulfil the expected goals. This find is in concordance with the experiences of the patients and the relatives and to some extent, can be explained, by the employees’ way of understanding the quality indicators. The most probable explanation to the low fulfilment of the goals is the employees’ experience of lack of management, coherence, and meaningfulness in their daily activities.

Conclusion: There is a consistent connection between the three perspectives. The perspective of the employees describes possible causes to the low part of clinical indicators of quality, which fulfil the goals. The perspective of patients and relatives points at the consequences of this.

The triangulation of the methods in an evaluation of organizational changes has shown a successful way, to understand conditions and coherence in the results of an organizational change, than the traditional method of evaluation.

Place, publisher, year, edition, pages
2007. , 39 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2007:16
Keyword [en]
Evaluation, Management, Leadership, Indicators of Quality, Geriatric Care.
Keyword [da]
Evaluering, ledelse, lederskab, kvalitetsindikatorer, geriatri.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3208OAI: oai:DiVA.org:norden-3208DiVA: diva2:725468
Presentation
2007-06-08, Nordic School of Public Health NHV, Box 12133, 404 42 Göteborg, Sweden, 13:00 (Danish)
Supervisors
Note

ISBN 978-91-85721-20-7

Available from: 2014-06-16 Created: 2014-06-16 Last updated: 2014-07-08Bibliographically approved

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