Five years after the Institute of Medicine (IOM) called for a redesigned U.S. health care system, relatively little was known about the extent to which hospitals had undertaken quality improvement (QI) efforts to address deficiencies in patient care. To examine the state of hospital QI activities in 2006, the authors designed and conducted a survey of short-term, general hospitals with 25 or more beds. In a sample of 470 hospitals, they found that many were actively engaged in improvement efforts but that these activities varied in method and impact. Hospitals with high levels of perceived quality, as reflected in assessments by their quality managers, were more likely to have embraced QI as a strategic priority, employed quality practices and processes consistent with IOM aims, fostered staff training and involvement in QI methods, engaged in an array of QI activities and clinical QI strategies, and maintained staffing levels favoring fewer patients per nurse.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288, 1987-1993.
2.
American Hospital Association. (2005). AHA annual survey database. Chicago: Health Forum.
3.
Berwick, D.M., Godfrey, A.B., & Roessner, J. (1990). Curing health care: New strategies for improvement . San Francisco: Jossey-Bass.
4.
Galvin, R., & Milstein, A. (2002). Large employers' new strategies in health care . New England Journal of Medicine, 347, 939-942.
5.
Heget, J.R., Bagian, J.P., Lee, C.Z., & Gosbee, J.W. (2002). John M. Eisenberg Patient Safety Awards: System innovation: Veterans Health Administration National Center for Patient Safety . Joint Commission Journal of Quality Improvement, 28, 660-665.
6.
Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.
7.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
8.
Jha, A.K., Li, Z., Orav, E.J., & Epstein, A.M. (2005). Care in U.S. hospitals-The Hospital Quality Alliance program. New England Journal of Medicine, 353, 265-274.
9.
Kizer, K.W. (2001). Re-engineering the veterans healthcare system . In P. Ramsaroop, M. J. Ball, D. Beaulieu, & J. V. Douglas (Eds.), Advancing federal sector health care: A model for technology transfer (pp. 79-96). New York: Springer-Verlag.
10.
Laschober, M., Maxfield, M., Felt-Lisk, S., & Miranda, D.J. (2007). Hospital response to public reporting of quality indicators. Health Care Financing Review, 28, 61-76.
11.
Leape, L.L., & Berwick, D.M. (2005). Five years after To err is human. What have we learned? Journal of the American Medical Association, 293, 2384-2390.
12.
Leapfrog Group. (2005). Hospital Quality and Safety Survey. Retrieved 2005 from http://leapfrog.medstat.com/(aud0023jrc3sa245wvvd3vrp)/index.aspx#refmaterials
13.
McGlynn, E.A., Asch, S.M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., et al. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine , 348, 2635-2645.
14.
Mitchell, T.R. (1985). An evaluation of the validity of correlational research conducted in organizations. Academy of Management Review, 10, 192-205.
15.
National Quality Forum. (2002). Serious reportable events in patient safety: A consensus report. Washington, DC: Author.
16.
National Quality Forum. (2003). Safe practices for better health care: A consensus report. Washington, DC: Author.
17.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine , 346, 1715-1722.
18.
Prentice J.C., & Pizer, S.D. (2007). Delayed access to health care and mortality. Health Services Research, 42, 644-662.
19.
Reinertsen, J.L., Gosfield, A.G., Rupp, W., & Whittington, J.W. (2007). Engaging physicians in a shared quality agenda. Cambridge, MA: Institute for Healthcare Improvement.
20.
Ross, J.S., Cha, S.S., Epstein, A.J., Wang, Y., Bradley, E.H., Herrin, J., et al. (2007). Quality of care for acute myocardial infarction at urban safety-net hospitals. Health Affairs, 26, 238-248.
21.
Shortell, S.M. (1995). National survey of hospital efforts to improve quality. Evanston, IL: Northwestern University.
22.
Shortliffe, E.H. (2005). Strategic action in health information technology: Why the obvious has taken so long. Health Affairs, 24, 1222-1233.
23.
Shwartz, M., Ren, Z.J., Peköz, E., Wang, X., Cohen, A.B., & Restuccia, J. (in press). Estimating a composite measure of hospital quality from the Hospital Compare database: Differences when using a Bayesian hierarchical latent variable model versus denominator-based weights. Medical Care.
24.
Wachter, R.M. (2004). The end of the beginning: Patient safety five years after "To Err is Human." Health Affairs, 23, W534-W545.
25.
Wagner, E.H., Austin, B.T., & Von Korff, M. (1996). Organizing care for patients with chronic illness . Milbank Quarterly, 74, 511-544.
26.
Weiner, B.J., Alexander, J.A., Shortell, S.M., Baker, L.C., Becker, M., & Geppert, J.J. (2006). Quality improvement implementation and hospital performance on quality indicators. Health Services Research , 41, 307-334.
27.
Winters, B.D., Pham, J., & Pronovost, P.J. (2006). Rapid response teams-Walk, don't run. Journal of the American Medical Association, 296, 1645-1647.
