PubMed · 10297781
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J R Green. 1975. Design for user needs.. https://pubmed.ncbi.nlm.nih.gov/10297781/
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INTRODUCTION: The aim of this study was to identify organisational difficulties faced by physicians and nurses when using drug prescribing sheets for the recording of both drug prescriptions and drug administration. MATERIAL AND METHODS: Qualitative interviews with seven physicians and eight nurses from two general internal medicine wards. Main outcome measures were the difficulties explicitly identified during the interviews. RESULTS: The implementation of procedures conflicted with existing structure, culture, and routines. Insufficient competence within the system to use the drug prescribing sheets created resistance and made people create their own solutions to the problems they faced. A total of nine difficulties were identified: 1) insufficient knowledge and uncertainty about procedures, 2) ignorance of sources of error, 3) unclear responsibilities, 4) low community spirit, 5) insufficient communication, 6) clinician autonomy and low acceptance of change, 7) strong professional identity, 8) low priority task, and 9) logistic problems. DISCUSSION: Unawareness of procedures, insufficient dissemination of knowledge, and insufficient cooperation and skepticism among those who put drug handling into practice is likely to have an impact on the quality of health care. The identification of these obstacles may help managers to improve the quality of the drug handling process and make it possible to select a framework for changing the clinical behavior of doctors and nurses.
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It is not clear how policy-making in the field of reproductive health relates to changes associated with programmes for the reform of the health sector in developing countries. There has been little communication between these two areas, yet policy on reproductive health has to be implemented in the context of structural change. This paper examines factors that limit dialogue between the two areas and proposes the following framework for encouraging it: the identification of policy groups and the development of bases for collaborative links between them; the introduction of a common understanding around relevant policy contexts; reaching agreement on compatible aims relating to reproductive health and health sector change; developing causal links between policy content in reproductive health and health sector change as a basis for evidence-based policy-making; and strengthening policy-making structures, systems, skills, and values.