Journal of Healthcare Management - March/April 2014 - (Page 121)

l e a d e rs H i p p erceptions of s tructures , p rocesses , contrast between the two groups. We conducted t tests for each respondent group to determine whether the average domain scores for high- and lowperforming hospitals were significantly different on the Process Index at a bivariate level. To test the second question, whether perceptions differed between the respondent groups, the HLQAT domain scores were averaged by respondent type (board, C-suite, and clinical manager) for each hospital. The domain scores were compared across respondent types using ANOVA in SAS's Proc GLM to control for the fact that there were different numbers of respondents in each group at each hospital. All analyses were conducted in SAS 9.2 (SAS Institute, 2009). R E S U LT S As indicated in Table 2, compared to all U.S. community general hospitals, the hospitals in these analyses tend to be larger, are more likely to be located in an urban setting, and are less likely to be located in the U.S. West and more likely to be located in the Midwest. They are also slightly more likely to be teaching, nonprofit or for-profit hospitals and slightly less likely to be system members (AHA, 2010). Table 2 also describes the total number of respondents, as well as the average number of respondents per hospital and the standard deviation. Cronbach's alphas were calculated for each domain for each respondent group (results are available from the corresponding author). Most are in the 0.80 range or above, demonstrating acceptable reliability. The lowest alphas for all three groups were for public reporting of quality and for clearly defined QI and p riorities for Q uality leadership. For each of these domains, the alphas are marginally acceptable for a new scale (Nunnally, 1978). The first question investigated whether higher HLQAT scores were associated with better performance on the CMS Core Measures-based Process Index. Regardless of which respondent group was considered, hospitals whose respondents had, on average, more positive perceptions on the HLQAT domains also had higher Process Index scores. This relationship was consistently statistically significant across all three respondent groups (9 of 13 among boards, 10 of 13 among C-suites, and 10 of 11 among clinical management). In seven domains, the average scores for all three groups were higher for the high-performing hospitals. In all but two domains, at least two respondent groups exhibited significantly higher domain scores for high-performing hospitals. For just/nonpunitive culture, only the board scores differed, and for adequate resources, only the clinical manager scores differed. With the exception of two tie scores, in every domain, including those with nonsignificant differences, high-performing hospitals exhibited higher domain scores than low-performing hospitals did (Table 3). The second research question was whether there were systematic differences in the perceptions of the three respondent groups at a hospital. The analysis revealed systematic and significant differences: Board respondents were generally more positive in their assessments than either C-suite or clinical management respondents, and these differences existed in all types of hospitals, regardless of size, teaching or 121

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