Journal of Healthcare Management - March/April 2014 - (Page 115)

l e a d e rs H i p p erceptions of s tructures , p rocesses , 2006; Frankel et al., 2006). Staff in highperforming hospitals have access to, and are expected to consistently use, effective clinical support mechanisms (use of clinical management tools) (Classen & Kilbridge, 2002; Dixon & Shofer, 2006). Successful hospital leaders also recognize the importance, both symbolic and practical (reinforcement), of celebrating and rewarding goal achievement (employees rewarded for meeting QI goals) (Classen & Kilbridge, 2002; Ruchlin et al., 2004). According to the proposed conceptual model, senior leaders in higherperforming hospitals are also committed to monitoring performance and adaptation based on documented progress toward goals (monitor and evaluate QI and perceived overall QI). This process entails providing feedback to key stakeholders and holding them and other participants accountable to one another and to the community (public reporting of quality) so that appropriate adjustments can be made to programs and policies (Beer, 2000; Prybil et al., 2005; Reeleder et al., 2006). Two forms of the instrument were developed, labeled A and B, each consisting of approximately 100 items. Form A, which addressed all 13 domains, was completed by board members; senior, or C-suite, executives, including CEOs, chief operating officers, chief medical officers, chief nursing officers, chief financial officers, and vice presidents; and QI professionals. Form B, completed by clinical managers, including physicians, nurses, and individuals overseeing clinical departments such as nursing units and laboratories, did not include two and p riorities for Q uality domains-collaboration across functions and levels and quality improvement education for all staff)-because of missing data and the distribution of responses from a pilot test; a third domain (monitoring and evaluating QI progress) used different response scales for the two forms (Table 1). This study addresses two questions: 1. Are higher domain scores on the HLQAT correlated with higher performance on various clinical measures? If so, the HLQAT may be a valuable instrument for identifying areas for improvement related to clinical quality. 2. Do governing boards, C-suites, and clinical management possess different perceptions regarding structures, processes, and qualityrelated activities in their hospital? If so, communication and collaboration among the three groups must be improved to better focus efforts aimed at quality improvement. S A M P L E A N D D ATA COLLECTION A convenience sample of hospitals was recruited through and encouraged by several avenues, such as state hospital associations; QIOs; and national quality improvement organizations, including the Institute for Healthcare Improvement. Surveys were hosted online and conducted from mid-November 2009 through January 2010. Respondents identified their respective hospital roles. Survey data were linked to American Hospital Association (AHA) hospital characteristics data and to Centers for 115

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