Assessing the Impact of Total Quality Management and Organizational Culture on Multiple Outcomes of Care for Coronary Artery Bypass Graft Surgery Patients

Shortell, Stephen M.; Jones, Robert H.; Rademaker, Alfred; Gillies, Robin R.; Dranove, David; Hughes, Edward F. X.; Budetti, Peter P.; Reynolds, Kate; Huang, Cheng Fang

doi:10.1097/00005650-200002000-00010

Cited by 228 publications

(180 citation statements)

References 21 publications

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“…Few of these studies, however, examined the effectiveness of hospital QI practices. With few exceptions (e.g., Westphal, Gulati, and Shortell 1997;Shortell et al 2000), most have used perceptual measures of impact or self-reported estimates of cost or clinical impact rather than objectively derived measures of clinical quality (Gilman and Lammers 1995;Shortell et al 1995b). Other multisite, comparative studies have explicitly examined the impact of hospital QI on clinical practice (Carlin, Carlson, and Nordin 1996;O'Connor et al 1996;Gordian and Ballard 1997;Goldberg et al 1998;Ferguson et al 2003).…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

Self Cite

140

106

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Objective. To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources. Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design. Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods. Moreover, as much as one-third of some hospital procedures expose patients to risks without improving their health; one-third of drugs prescribed are not indicated; and one-third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and Brook 1988;Brook et al. 1990;Leape 1994; Institute of Medicine 2000).Many believe that quality improvement (QI) represents a promising strategy for improving hospital quality of care. QI is a systemic approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problem solving tools and empowered to make decisions based on their analysis of the data. The systemic focus of QI complements a growing recognition in the field that the quality of the care delivered by clinicians depends substantially on the performance capability of the organizational systems in which they work. While individual clinician competence remains important, many increasingly see the capability of organizational systems to prevent errors, coordinate care among settings and practitioners, and ensure that relevant, accurate information is available when needed as critical elements in providing high quality care (Institute of Medicine 2000). Reflecting the growing emphasis on organizational systems of care, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Peer Review Organizations of the Centers for Medicare and Medicaid have all encouraged hospitals to use QI methods.Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Shortell, Bennett, and Byck 1998). By implementation, we refer to the transition period, following a decision to adopt a new idea or practice, when intended users put that new idea or practice into use--for example, when clinical and nonclinical staff begin applying QI principles and practices to improve clinical care processes ( et al. 2004). In addition, the systemic nature of many quality problems implies that the effectiveness of a QI initiative may depend on its implementation across many conditions, disciplines, and departme...

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Section: Introductionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

Self Cite

140

106

View full text Add to dashboard Cite

show abstract

“…Participation, good communication, conflict resolution, and empowerment were reported to be related to resident outcomes [15,16,[18][19][20][21] . Furthermore, Shortell et al isolated attributes of the work environment and showed that they influence performance in acute hospitals [13,14] and that organizations with positive cultures were more likely to have adopted and internalized continuous quality improvement programs [25] . To achieve both better job satisfaction and quality of care in palliative care, the negative qualities that respondents perceived in the work culture in this study must be minimized, and focus must be given to the qualities that are positive for the work culture.…”

Section: How Do Health Care Personnel At a Pmu Expect The Future Workmentioning

confidence: 99%

“…This is important not only for giving the health care workers empowerment and legitimacy in their working situations but also to avoid stress and burnout [10] . It is important also for the quality of the care in these units because organizations with positive work cultures are more likely to have adopted and internalized continuous quality improvement programs [25] .…”

Section: What Are the Differences Between These Two Perspectives?mentioning

confidence: 99%

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Expectations and desires of palliative health care personnel concerning their future work culture

André

Sjøvold

Holmemo³

et al. 2013

JHA

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Introduction: Exploring the work culture of health care personnel is important in order to understand the challenges they face and the issues they experience. Believing in and shaping their futures indicates a working culture influenced by promoting factors. The aims of this study were to explore how health care workers at a Palliative Medicine Unit perceive their future work culture would be and whether they perceive that their expectations and desires will be fulfilled. Design: A correlational study.Methods: Health care personnel, physicians, nurses, physiotherapists, and others (N = 26) at a PMU in Norway completed a questionnaire according to the two perspectives, expectations (future) and desire (wish). The findings in these two perspectives were compared. The method seeks to explore what aspects dominate the particular work culture and identifying challenges, limitations, and opportunities. The findings were also compared with a reference group of 347 ratings of well-functioning Norwegian organizations, named the "Norwegian Norm". Results:The findings for the wish perspective showed significant (p<0.05; p<0.01) higher rates for nurturing and synergy dimensions and significant lower rates (p>0.05; p>0.05) for opposition and control dimensions than the findings for the future perspective.Conclusions: It appears that the health care personnel wish for changes that they don't believe they will achieve. The changes the respondents wish for are fewer negative work culture qualities, such as assertiveness and resignation, and more positive work culture qualities, such as engagement and empathy. Changes must be made to give the health care personnel improved working conditions and empowerment in order to change their situations to reflect what they wish for. The present findings can give an indication as to the direction that research ought to follow in subsequent studies.

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“…Several studies have examined the structures, processes, and relationships common to designing, organizing, and implementing hospital quality improvement efforts (Barsness et al, 1993a,b;Blumenthal & Edwards, 1995;Gilman & Lammers, 1995;Shortell et al, 1995bShortell et al, , 2000Weiner, Alexander, & Shortell, 1996, Weiner, Shortell, & Alexander, 1997. These studies indicate that hospitals vary widely in terms of: (1) their approach to implementing QI; (2) the extent to which QI has affected core clinical processes; and (3) the degree to which QI practices have been diffused across clinical areas.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement and hospital financial performance

2006

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SummaryThe objective of this study was to examine the association between the scope and intensity of Quality improvement (QI) implementation in hospitals and organizational performance. A sample of 1,784 community hospitals was used to assess relationships between QI implementation approach and two hospital-level performance indicators: cash flow and cost per case. Two-stage instrumental variables estimation, in which predicted values (instruments) of eight QI intensity and scope variables plus control (exogenous) variables were used to estimate hospital-level performance indicators. Our results suggest that QI has a measurable impact on global measures of organizational performance and that both control and leaning approaches to QI matter in these settings. Hospitals that implement QI effectively can reasonably expect to improve their financial and cost performance, or at least not place the hospital at risk for investing in quality improvement. These outcomes are specific to QI strategies that emphasize both control and learning.

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Assessing the Impact of Total Quality Management and Organizational Culture on Multiple Outcomes of Care for Coronary Artery Bypass Graft Surgery Patients

Cited by 228 publications

References 21 publications

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Expectations and desires of palliative health care personnel concerning their future work culture

Quality improvement and hospital financial performance

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