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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