一起试错:整合性护理网络实施中的发散思维与集体学习

Trial and error,together:divergent thinking and collective learning in the implementation of integrated care networks

建立混合网络把专业人员与组织联结起来,是为患者提供整合性护理的一种常用方法。最新研究文献认为,这些网络的成功实施需要以一种社会认知视角对利益相关者的心理模式与思维过程进行优选区分、调查研究和比较。本文的目的是研究加拿大安大略省名为"保健链"的整合性护理网络在实施过程中临床方面和管理方面的利益相关者的思想分歧,并描述促进利益相关者共同学习和培养更具一致性的观点的策略。根据共同心理模式理论和基于实践的学习理论,我们对"保健链"实施中涉及的55位医疗保健专业人员和管理者的访谈数据进行了二级分析。利益相关者在看待"保健链"的设计与方法("策略认知的心理模式")方面、在了解对方以及如何与对方合作("关系认知的心理模式")方面都存在分歧,我们对这些分歧案例进行了识别。我们还界定了促进学习与尽可能使心理模式统一的四种策略。该研究的结果会有助于指导利益相关者为提供整合性护理而就共同学习与协调行动展开对话。

Hybrid networks that link disparate professionals and organizations are a common approach to deliver integrated care to patients.Recent literature argues that successful implementation of these networks demands a socio-cognitive perspective in which stakeholder mental frames and thought processes are prioritized,investigated,and compared.The aims of this article are to identify where mindsets diverge among clinical and managerial stakeholders involved in the implementation of integrated care networks known as‘Health Links’(HLs)in Ontario,Canada,and to describe strategies to support stakeholders’capacity to collectively learn and develop more convergent views.Drawing from shared mental model theory and practice-based learning theory,a secondary analysis was conducted of interview data with 55 healthcare professionals and managers involved in the implementation of HLs.We identified examples of divergences in stakeholders’conceptualization of the HL design and approach(‘strategy mental model’)and their perceptions of each other and how they work together(‘relationship mental model’).We also identified four strategies that facilitate learning and possibly mental model convergence.The results of the study may help guide stakeholder dialogue towards collective learning and coordinated action for integrated care delivery.