Quality Implementation

3-12 Alexander Spr 07

5/8/07

9:55 AM

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Does Quality Improvement Implementation Affect Hospital Quality of Care?

JEFFREY A. ALEXANDER, BRYAN J. WEINER, STEPHEN M. SHORTELL, and LAURENCE C. BAKER

Abstract. The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital. Keywords: hospital quality indicators, implementation, quality improvement

Q

uality Improvement (QI) is a systemic approach to planning and implementing continuous improvement in performance that is common in healthcare systems. QI emphasizes continuous examination and improvement of work processes by teams of organizational members who are trained in basic statistical techniques and problem-solving tools and empowered

to make decisions on the basis of their data analysis. Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Ferlie and Shortell 2001; Institute of Medicine [IOM] 2001; Meyer et al. 2004; Shortell, Bennett and Byck 1998). Several researchers have examined the structures, processes, and relationships common to designing, organizing, and implementing hospital QI efforts (Barsness,...