BackgroundSeveral countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice.MethodSeven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews.ResultsA significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department.ConclusionsPublic policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.
No abstract
Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. http://creativecommons.org/licenses/by/4.0/deed.pt_BR To institute conflictive cooperation on the quality of workInstituir a cooperação conflitante sobre a qualidade do trabalho Instituir la cooperación conflictiva sobre la calidad del trabajo Instituer la coopération conflictuelle sur la qualité du travail *Jean-Yves Bonnefond* **antoine Bonnemain** ***flávio fernandes fontes*** ****Yves Clot**** AbstrActActivity Clinic is an active methodology to change work. We show how an experimental device on the quality of work is established at the Flins factory, after a request from Renault corporation. The method of crossed self-confrontation is used with operators of an assembly unit of doors. The results produced are discussed with management, direction and unions. The quality of the analysis and of the dialogue practiced in the device has helped solve performance and health problems that were initially ignored or repressed, as in the example of assembling a given part (coulisse). The recognition of the value of the experience made "at the doors" leads to the design and generalization of an organizational device throughout the assembly department. By the end of 2015, it was deployed in five departments of the factory, where a different "social dialogue" is being developed in the service of sustainable performance, conceived also as a source of health.Keywords: occupational health; job performance; quality of work. resumoA Clínica da Atividade é uma metodologia de ação para mudar o trabalho. Nós mostramos como um dispositivo experimental sobre a qualidade do trabalho é instituído na usina de Flins, a partir de uma demanda da empresa Renault. O método da autoconfrontação cruzada é utilizado com operadores de uma unidade de montagem de portas. Os resultados produzidos são objeto de um diálogo com a equipe no atelier e nos comitês de acompanhamento com a direção e sindicatos. A qualidade das análises e dos diálogos instituídos assim em diferentes níveis permitiu responder a problemas de desempenho e saúde ignorados ou reprimidos, como no exemplo da montagem de uma peça (coulisse). O reconhecimento do valor da experiência feita "com as portas" leva à concepção e generalização de um dispositivo organizacional em todo o departamento de montagem. No fim de 2015 o dispositivo é desenvolvido nos cinco departamentos de fabricação da usina, onde se desenvolve outro "diálogo social" a serviço de um desempenho durável, fonte de saúde.Palavras-chave: Saúde ocupacional. Desempenho no trabalho. Qualidade do trabalho.resumen La Clínica de la Actividad es una metodología de acción para cambiar el trabajo. Mostramos cómo un dispositivo experimental sobre la calidad del trabajo es instituido en la fábrica de Flins, a partir de una demanda de la empresa Renault. El método de la auto-confrontación cruzada es util...
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