Implementation of quality management systems: the role of hospital (management) boards.
Bibliographic record
Abstract
Objectives: Hospitals are putting tremendous efforts in implementing evidence-based management systems and organisational innovations for patient-centred care. Having a hospital quality management system is a prerequisite to successfully implement these innovations. Previous studies showed that the effectiveness of implementing innovations was not only associated with the Hospital (management) Board’s commitment to quality, but also with external pressures such as accreditation, legislation and market competition. Recent studies in the US, Canada and Europe have shown that the implementation of quality management systems differs tremendously between hospitals. Therefore, our objective was to determine whether the level of implementation is influenced by the Hospital Board’s commitment to quality of care and external pressures such as accreditation and legislation. Methods: Our study was a cross-sectional international comparative survey in Europe Data collection took place in 2011. Questionnaires measuring Board behaviour and hospital quality management consisted of previously validated scales if possible, and were deployed in seven European countries using a forward-backward translation strategy. We approached CEOs and quality managers in 210 hospitals in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Results: We obtained data from 188 hospitals, showing a large variation in the development of hospital quality management systems, of the Hospital (management) Boards’ commitment to quality of care, and the influence of external pressures. Using a linear multivariable regression model at hospital level with random incept by country (adjusted for confounding effects at hospital level), results show that quality management systems are more developed when Hospital (management) Boards were more committed to quality of care. We found no mediation effect of perceived external pressure. Conclusion: Our results show that Hospital (management) Boards can influence the implementation of quality management systems, provided that they are committed to quality of care. As a hospital quality management system is a prerequisite to deliver high quality patient-centred care, it provides hospital Boards with the opportunity to comply to their legal accountability for quality of care by facilitating its development and implementation. References: Shaw CD, Groene O, Mora N, Suñol R. Accreditation and ISO certification: do they explain differences in quality management in European hospitals? References: Shaw CD, Groene O, Mora N, Suñol R. Accreditation and ISO certification: do they explain differences in quality management in European hospitals? Int J Qual Health Care 2010; 22 (6):445-51. Vaughn T, Koepke M, Kroch E, Lehrman W, Sinha S, Levey S. Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. J Pat Saf 2006; 2 (1):2‐9.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.042 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".