Promoting quality: the health-care organization from a management perspective.

BACKGROUND Although agreement about the need for quality improvement in health care is almost universal, the means of achieving effective improvement in overall care is not well understood. Avedis Donabedian developed the structure-process-outcome framework in which to think about quality-improvement efforts. ISSUE There is now a robust evidence-base in the quality-improvement literature on process and outcomes, but structure has received considerably less attention. The health-care field would benefit from expanding the current interpretation of structure to include broader perspectives on organizational attributes as primary determinants of process change and quality improvement. SOLUTIONS We highlight and discuss the following key elements of organizational attributes from a management perspective: (i) executive management, including senior leadership and board responsibilities (ii) culture, (iii) organizational design, (iv) incentive structures and (v) information management and technology. We discuss the relevant contributions from the business and medical literature for each element, and provide this framework as a roadmap for future research in an effort to develop the optimal definition of 'structure' for transforming quality-improvement initiatives.

[1]  Fang-Shu Ou,et al.  Pay for performance, quality of care, and outcomes in acute myocardial infarction. , 2007, JAMA.

[2]  Sheila Roman,et al.  Public reporting and pay for performance in hospital quality improvement. , 2007, The New England journal of medicine.

[3]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[4]  G. Annas.  The patient's right to safety--improving the quality of care through litigation against hospitals. , 2006, The New England journal of medicine.

[5]  R. Kaplan,et al.  How to implement a new strategy without disrupting your organization. , 2006, Harvard business review.

[6]  Børge Obel,et al.  Organizational Design : A Step-by-Step Approach , 2006 .

[7]  Federico Lega,et al.  Converging patterns in hospital organization: beyond the professional bureaucracy. , 2005, Health policy.

[8]  J. Orlikoff,et al.  Trustee workbook 4. Board self-evaluation turns 20: lessons learned and future trends. , 2005, Trustee : the journal for hospital governing boards.

[9]  Alice G Gosfield,et al.  The 100,000 lives campaign: crystallizing standards of care for hospitals. , 2005, Health affairs.

[10]  James E Orlikoff,et al.  Trustee workbook 2. The balanced scorecard: a tool for maximizing board performance. , 2005, Trustee : the journal for hospital governing boards.

[11]  Kanak S Gautam.  A Call for Board Leadership on Quality in Hospitals , 2005, Quality management in health care.

[12]  Gregory T. Carrott,et al.  Culture Matters Most , 2005 .

[13]  S. Ryan.  The spirit of leadership and a commitment to quality transform SSM health care system , 2004 .

[14]  P. Hudson,et al.  Applying the lessons of high risk industries to health care , 2003, Quality & safety in health care.

[15]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[16]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[17]  P. Pronovost,et al.  Improving communication in the ICU using daily goals. , 2003, Journal of critical care.

[18]  F Moss.  QSHC 2003: now bimonthly , 2003 .

[19]  Donald M. Berwick,et al.  Connections Between Quality Measurement and Improvement , 2003, Medical care.

[20]  H. Krumholz,et al.  A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed? , 2001, JAMA.

[21]  G. Meyer,et al.  The forgotten component of the quality triad: can we still learn something from "structure"? , 2001, The Joint Commission journal on quality improvement.

[22]  H. Krumholz,et al.  A Qualitative Study of Increasing β-Blocker Use After Myocardial Infarction: Why Do Some Hospitals Succeed? , 2001 .

[23]  Paul N. Finlay,et al.  An empirical study of the use of information technology to support total quality management , 2001 .

[24]  S. Eastaugh.  Hospital costs and specialization: benefits of trimming product lines. , 2001, Journal of health care finance.

[25]  J. Meliones,et al.  Saving money, saving lives. , 2000, Harvard business review.

[26]  A Milstein,et al.  Improving the safety of health care: the leapfrog initiative. , 2000, Effective clinical practice : ECP.

[27]  R H Brook,et al.  The public release of performance data: what do we expect to gain? A review of the evidence. , 2000, JAMA.

[28]  S M Shortell,et al.  Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coronary artery bypass graft surgery patients. , 2000, Medical care.

[29]  M. Chassin.  Is health care ready for Six Sigma quality? , 1998, The Milbank quarterly.

[30]  Kevin Laframboise,et al.  A qualitative analysis of leadership and quality improvement , 1998 .

[31]  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.

[32]  Karlene H. Roberts,et al.  Organizational Culture in High Reliability Organizations: An Extension , 1995 .

[33]  Irwin M. Rubin,et al.  Organizational Behavior: An Experiential Approach , 1994 .

[34]  Vijay Gurbaxani,et al.  The impact of information systems on organizations and markets , 1991, CACM.

[35]  Joseph Moses Juran.  Juran on leadership for quality : an executive handbook , 1989 .

[36]  Richard Whittington,et al.  Exploring Corporate Strategy , 1988 .

[37]  J. Greenberg,et al.  Behavior in Organizations , 1983 .

[38]  J Genest,et al.  [The quality of medical care]. , 1971, L'union medicale du Canada.