Review: how do hospital organizational structure and processes affect quality of care? A critical review of research methods
LR Hearld; JA Alexander, I Fraser, HJ Jiang
Medical Care Research and Review, 2008, 65(3), pp259-299
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Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. In order to achieve breakthrough improvements in quality, patient safety, and resource utilization, hospitals and health systems require a "world class" quality management foundation that includes:
Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.
Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables "real time" information.
Process: including concurrent intervention, the ability to identify key quality performance "gaps," and performance improvement tools and methodologies to effectively eliminate quality issues.
Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay "survey ready every day."
Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.
My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.
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