Senior hospital managers influence efforts to improve quality of care, a Yale study reports in the current issue of the Journal of Healthcare Management.
The study indicates that the culture of a hospital, as fostered by the hospital managers, may play a more important role than previously realized in sustaining and promoting high quality care.
"Management is an under-appreciated key element in quality improvement," said Elizabeth Bradley, director of the Health Management Program in the Department of Epidemiology and Public Health at Yale School of Medicine, and lead author of the study. "Managers, it seems, can create the context for positive changes in clinical care."
Bradley said quality improvement has long been felt to be the function of clinicians. Hospital administrators are usually thought to focus their efforts on staffing and budgets. This in-depth study of a number of hospitals around the country revealed that hospital administrators play many important roles that influence the quality of hospital care. Focusing specifically on the care of patients with heart attacks, the study found that administrators differed in their communication with clinicians, their commitment to allocating resources to improve care and their advocacy for improvement efforts.
"The study demonstrates the many ways that managers can influence clinical care," said Harlan M. Krumholz, M.D., professor of medicine at Yale and senior author of the study. "The findings suggest that at progressive hospitals, managers are engaged in efforts to improve care and work closely with the clinical staff."
The study included in-depth interviews with 45 clinical and administrative staff from eight hospitals across the country. The hospitals in the study were selected to represent a range of sizes, geographic regions, and beta-blocker improvement rates over a three-year period.
This work is part of a large study funded by the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services, to identify key success factors for improving quality care in hospitals.
Other authors on the study included Eric S. Holmboe, M.D., Jennifer A. Mattera, Sarah A. Roumanis, and Martha J. Radford, M.D.
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