Impacts of Organizational Context on Quality Improvement: don't forget internal management !

Frédéric Capuano, Antoine Crié, Philippe Loirat and Etienne Minvielle ()
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Frédéric Capuano: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale, Dept Food Microbiol - Istituto Zooprofilattico Sperimentale del Mezzogiorno, IGR - Institut Gustave Roussy
Antoine Crié: Centre de Technologie de Ladoux - Michelin - Manufacture Française des Pneumatiques Michelin, IGR - Institut Gustave Roussy
Philippe Loirat: EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, IGR - Institut Gustave Roussy
Etienne Minvielle: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP], IGR - Institut Gustave Roussy

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Abstract: To the Editor, In a recent article, Glasgow et al assessed the impacts of organizational context on quality improvement (QI). In their study of organizational characteristics of 100 hospitals participating in a national QI collaborative, they did not find any predictive associations with QI performance. Using a different approach, we conducted a study of 505 French hospitals that are subject to mandatory annual measurements of quality indicators in a national program aimed at promoting continuous quality improvement (CQI). This program is driven by the French Ministry of Health, the French Health Authority, and our research group (COMPAQ-HPST). From an analysis of the literature, we developed a theoretical frame that ranged potential factors of success for a CQI program along 2 axes. One concerned contextual factors (eg, staff stability, QI information), which covered the same organizational characteristics as described by Glasgow et al. The other included managerial factors (eg, managers use quality indicator results to define the hospi-tal's strategy, managers favor multiprofessional commitment when analyzing quality indicator results), which do not seem to have been considered in that article. Seventeen factors were identified and considered to be relevant by a panel of 22 health care professionals, using a consensus method. The relevance of these 17 factors was thereafter confirmed in 505 hospitals by assessing the correlation between the presence/absence of these factors and the results of 3 quality indicators (quality of patient medical records, pain assessment, and delay in sending information at patient discharge). A factorial analysis showed that the managerial axis included 6 factors and the contextual axis included 11. Cronbach α for the 2 axes were .78 and .82, respectively. A multivariate analysis showed a link between managerial score and the results of an indicator assessing the quality of patients' medical records (P = .02) and an indicator measuring the delay in sending information at patients' discharge (P = .03). We believe that managerial capacity is an important factor in the success of QI programs and should be analyzed more precisely.

Keywords: management; hospital (search for similar items in EconPapers)
Date: 2013
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Published in American Journal of Medical Quality, 2013, 28, pp.176 - 176. ⟨10.1177/1062860612456730⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01573360

DOI: 10.1177/1062860612456730

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