Journal of Healthcare Management - March/April 2014 - (Page 112)
J o u r n al
of
H ealt H care M anage Ment 59:2 M arcH /a pril 2014
BACKGROUND
While progress in hospital quality and
safety has been evident since the release
of the Institute of Medicine's (IOM)
reports To Err Is Human (1999) and
Crossing the Quality Chasm (2001), its
advance has "proven slow and arduous,"
and the extent and rate of advance is
difficult to measure (Pronovost, Miller,
Wachter, & Meyer, 2009).
Multiple roadblocks have hindered
this progress. Studies have shown
that quality and safety issues do not
rank as a top priority for CEOs and
boards of directors (ACHE, 2011; Jha
& Epstein, 2010). Furthermore, insufficient resources have been allocated for
quality/safety educational programs,
especially for boards (Jha & Epstein,
2010), and for programs in quality
improvement for physicians and executives (Gautam, 2005). Communication
structures that facilitate confrontation
and resolution of problems are often
less than salutary (Bohmer, 2010).
The knowledge and communication
issues stretch from board-medical staff
relations to the front line, where medical mistakes usually occur. A number of
scholars have argued that failure of systems thinking has been a major obstacle
to upgrading quality and safety (Shortell & Singer, 2008). Systems thinking
is effective only if the members of the
system share a common basis for assessment of the current situation and goals
for change. Appropriate governance and
accountability and the need to speak
a common language across all levels
regarding quality and safety are urgently
needed (Shortell & Singer, 2008). Yet,
while several researchers examined
differences between frontline workers'
perceptions and those of senior managers and supervisors, comparisons that
include the governing board are lacking
(Singer, Falwell, Gaba, & Baker, 2008).
From Rhetoric to Action
Levey et al. (2007) interviewed board
and C-suite-level leaders of 18 U.S. community hospitals and identified considerable gaps between rhetoric regarding
quality improvement and actual performance. They concluded that greater
commitment from boards and CEOs to
a culture of quality is needed, including collaboration between governing
boards, C-suites, and physicians in
quality improvement activities. Levey
et al. (2007) were not able to include
objective performance measures in their
study, nor did they interview mid-level
managers.
To assess internal and external
sources of performance improvement,
a short, web-based survey of hospital
leaders was subsequently conducted
by that research group (Vaughn et al.,
2006; Kroch et al., 2006). Results from
the survey indicated that higher quality scores (as measured by the Premier/
CareScience Quality Index) were associated with hospitals where the board
is more engaged in quality and where
the CEO is seen as the person with the
greatest impact on quality improvement
(Vaughn et al., 2006).
Based on the results of these studies
and this prior research, we recognized
the need for a more comprehensive and
systematic survey addressing key organizational features posited to be associated
with clinical quality, and to field it with a
larger and more diverse sample. The Hospital Leadership and Quality Assessment
112
Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014
Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line
Journal of Healthcare Management - March/April 2014
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