Building the Case for Quality Improvement in the Health Care Industry: A Focus on Goals and Training

Health care organizations are under intense pressure to improve the efficiency and effectiveness of care delivery and, increasingly, they are using quality improvement teams to identify and target projects to improve performance outcomes. This raises the question of what factors actually drive the performance of these projects in a health care environment. Using data from a survey of health care professionals acting as informants for 244 patient care, clinical-administrative, and nonclinical administrative quality improvement project types in 93 health care organizations, we focus on 2 factors—goal setting and quality training—as potential drivers of quality improvement project performance. We find that project-level goals and quality training have positive associations with process quality, while organizational-level goals have no impact. In addition, the relationship between project-level goals and process quality is stronger for patient care projects than for administrative projects. This indicates that the motivational and cognitive effects of goal setting are greater for projects that involve interactions with clinicians than for ones that involve interactions with other staff. Although project-level goal setting is beneficial for improving process quality overall, our findings suggest the importance of being especially attentive to goal setting for projects that impact direct patient care.

[1]  Jose M. Barrutia,et al.  Electronic Service Quality and Value , 2013 .

[2]  Terence T. Ow,et al.  Examining the impact of information technology and patient flow on healthcare performance: A Theory of Swift and Even Flow (TSEF) perspective , 2013 .

[3]  Sridhar Seshadri,et al.  Effect of quality management systems and total quality management on productivity before and after: Empirical evidence from the Indian auto component industry , 2013 .

[4]  Linda V. Green,et al.  OM Forum - The Vital Role of Operations Analysis in Improving Healthcare Delivery , 2012, Manuf. Serv. Oper. Manag..

[5]  Joseph Restuccia,et al.  Hospital implementation of health information technology and quality of care: are they related? , 2012, BMC Medical Informatics and Decision Making.

[6]  Dilip Chhajed,et al.  Job autonomy, trust in leadership, and continuous improvement: An empirical study in health care , 2012 .

[7]  R. L. Shrivastava,et al.  Total quality management: literature review and an agenda for future research , 2012 .

[8]  Kenneth K. Boyer,et al.  Process quality improvement: An examination of general vs. outcome-specific climate and practices in hospitals , 2012 .

[9]  Paula H Song,et al.  High-performance work systems in health care, Part 3: The role of the business case , 2012, Health care management review.

[10]  G. Dankbar,et al.  Highlights of the 2011 Mayo Clinic Systems Engineering and Operations Research conference , 2012 .

[11]  Kenneth K. Boyer,et al.  Process Management Impact on Clinical and Experiential Quality: Managing Tensions between Safe and Patient-Centered Healthcare , 2011, Manuf. Serv. Oper. Manag..

[12]  Linda R. LaGanga.  Lean service operations: Reflections and new directions for capacity expansion in outpatient clinics , 2011 .

[13]  Christian Terwiesch,et al.  The Effects of Focus on Performance: Evidence from California Hospitals , 2011, Manag. Sci..

[14]  Richard M J Bohmer,et al.  Fixing health care on the front lines. , 2010, Harvard business review.

[15]  Subhash C. Lonial,et al.  Impact of Quality Management on Hospital Performance: An Empirical Examination , 2010 .

[16]  James R. Langabeer,et al.  Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective , 2009 .

[17]  Charles R. Gowen,et al.  The patient safety chain: Transformational leadership's effect on patient safety culture, initiatives, and outcomes , 2009 .

[18]  M. Schweitzer,et al.  Goals Gone Wild: The Systematic Side Effects of Overprescribing Goal Setting , 2009 .

[19]  Rachna Shah,et al.  Explaining Anomalous High Performance in a Health Care Supply Chain , 2008, Decis. Sci..

[20]  P. Tsasis,et al.  Organizational change through Lean Thinking , 2008, Health services management research.

[21]  Jennifer E. Drake,et al.  A Survey of Hospital Quality Improvement Activities , 2008, Medical care research and review : MCRR.

[22]  N. Lurie,et al.  Challenges to using a business case for addressing health disparities. , 2008, Health affairs.

[23]  James A. Bovaird,et al.  Unconstrained Structural Equation Models of Latent Interactions: Contrasting Residual- and Mean-Centered Approaches , 2007 .

[24]  M. Rosenthal,et al.  Nonpayment for performance? Medicare's new reimbursement rule. , 2007, The New England journal of medicine.

[25]  Anita L. Tucker.  An Empirical Study of System Improvement by Frontline Employees in Hospital Units , 2007, Manuf. Serv. Oper. Manag..

[26]  Timothy D. Henry,et al.  A Regional System to Provide Timely Access to Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction , 2007, Circulation.

[27]  S. Somers,et al.  A business case for quality. , 2007, The American journal of managed care.

[28]  K. E. Kilpatrick,et al.  How to develop a business case for quality. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[29]  Xianggui Qu,et al.  Multivariate Data Analysis , 2007, Technometrics.

[30]  Roger G. Schroeder,et al.  Six sigma: The role of goals in improvement teams , 2006 .

[31]  Charles R. Gowen,et al.  Exploring the efficacy of healthcare quality practices, employee commitment, and employee control , 2006 .

[32]  E. A. Locke,et al.  New Directions in Goal-Setting Theory , 2006 .

[33]  W. C. Benton,et al.  Hospital technology and nurse staffing management decisions , 2006 .

[34]  M. Eccles,et al.  Welcome to Implementation Science , 2006, Implementation Science.

[35]  Steven J Spear,et al.  Fixing health care from the inside, today. , 2005, Harvard business review.

[36]  A. Slywotzky,et al.  Countering the biggest risk of all. , 2005, Harvard business review.

[37]  Susan Meyer Goldstein,et al.  Linking publicness to operations management practices: A study of quality management practices in hospitals , 2005 .

[38]  Susan Meyer Goldstein,et al.  The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals , 2004, Decis. Sci..

[39]  M. D. Blumenthal.  The Business Case for Quality: Ending Business as Usual in American Health Care , 2004 .

[40]  Craig A. Wendorf.  Primer on Multiple Regression Coding: Common Forms and the Additional Case of Repeated Contrasts , 2004 .

[41]  Scott B. MacKenzie,et al.  Common method biases in behavioral research: a critical review of the literature and recommended remedies. , 2003, The Journal of applied psychology.

[42]  F. Davidoff,et al.  The business case for quality: case studies and an analysis. , 2003, Health affairs.

[43]  E. A. Locke,et al.  Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. , 2002, The American psychologist.

[44]  W. C. Benton,et al.  The impact of strategic operations management decisions on community hospital performance , 2002 .

[45]  J. H. Gittell.  Relationships between Service Providers and Their Impact on Customers , 2002 .

[46]  P. Groenewegen,et al.  The effectiveness of quality systems in nursing homes: a review , 2001, Quality in health care : QHC.

[47]  A. Bakker,et al.  Burnout Contagion Among General Practitioners , 2001 .

[48]  S. Shortell,et al.  Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. , 1998, The Milbank quarterly.

[49]  S M Shortell,et al.  Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. , 1997, Health services research.

[50]  Janelle Heineke,et al.  Strategic operations management decisions and professional performance in U.S. HMOs , 1995 .

[51]  Richard B. Chase,et al.  Constructing an empirically derived measure for customer contact , 1995 .

[52]  Roger G. Schroeder,et al.  Relationship Between JIT and TQM: Practices and Performance , 1995 .

[53]  Dwight D. Frink,et al.  A Review of the Influence of Group Goals on Group Performance , 1994 .

[54]  Richard P. Bagozzi,et al.  Assessing Construct Validity in Organizational Research , 1991 .

[55]  Roger G. Schroeder,et al.  The effects of organizational context on quality management: An empirical investigation , 1991 .

[56]  Henry L. Tosi.  A Theory of Goal Setting and Task Performance , 1991 .

[57]  Tigineh Mersha,et al.  Enhancing the customer contact model , 1990 .

[58]  Jayant V. Saraph,et al.  An Instrument for Measuring the Critical Factors of Quality Management , 1989 .

[59]  D Blumenthal,et al.  The case for using industrial quality management science in health care organizations. , 1989, JAMA.

[60]  M. E. Tubbs,et al.  Goal setting: A meta-analytic examination of the empirical evidence. , 1986 .

[61]  David A. Tansik,et al.  The Customer Contact Model for Organization Design , 1983 .

[62]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .

[63]  Richard B. Chase,et al.  The Customer Contact Approach to Services: Theoretical Bases and Practical Extensions , 1981, Oper. Res..

[64]  G. Latham,et al.  A Review of Research on the Application of Goal Setting in Organizations , 1975 .

[65]  E. A. Locke.  Toward a theory of task motivation and incentives , 1968 .

[66]  Susan Meyer Goldstein,et al.  Ten years after: Interference of hospital slack in process performance benefits of quality practices , 2012 .

[67]  Anuj Saraogi,et al.  Assessing the evidence of Six Sigma and Lean in the health care industry. , 2011, Quality management in health care.

[68]  G. Carrin,et al.  WHO The world health report - health systems financing: the path to universal coverage. , 2010 .

[69]  Rolph E. Anderson,et al.  Multivariate Data Analysis (7th ed. , 2009 .

[70]  M. Johnston,et al.  Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory , 2007, Implementation science : IS.

[71]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[72]  P. Keizer.  Coordination and Communication , 2001 .

[73]  P. Bentler,et al.  Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives , 1999 .

[74]  Edwin A. Locke,et al.  Goal setting, planning, and performance on work tasks for individuals and groups. , 1997 .

[75]  Stephen M. Shortell,et al.  Health Care Management : Organization Design and Behavior , 1997 .

[76]  R. Guion.  Review of Managerial Behavior, Performance and Effectiveness. , 1971 .