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Implementation of quality management systems: the role of hospital (management) boards.

Botje, D., Klazinga, N.S., Suñol, R., Wagner, C. Implementation of quality management systems: the role of hospital (management) boards.: , 2013. 2542 p. Abstract. In: Abstractbook 15 Minute Oral Presentations. International Society for Quality in Health Care (ISQUA) 30th International Conference 'Quality and safety in population health and healthcare'. Edinburgh: ISQUA, 2013.
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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.