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Hadian SA, Rezayatmand R, Shaarbafchizadeh N, Ketabi S, Pourghaderi AR. Hospital performance evaluation indicators: a scoping review. BMC Health Serv Res 2024; 24:561. [PMID: 38693562 PMCID: PMC11064245 DOI: 10.1186/s12913-024-10940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. METHODS We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. RESULTS We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. CONCLUSION The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.
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Affiliation(s)
- Shirin Alsadat Hadian
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezayatmand
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nasrin Shaarbafchizadeh
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Ketabi
- Department of Management, Faculty of Administrative Sciences and Economics, University of Isfahan, Isfahan, Iran
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Jones D, Gingrich M, Anstee C, Najmeh S, Safieddine N, Darling G, Malthaner R, Finley C, French DG, Ferri L, Seely A. Multicentre positive deviance seminar to generate best practice recommendations to reduce anastomotic leak and length of stay for patients undergoing oesophagectomy. BMJ Open Qual 2023; 12:e002458. [PMID: 38114245 DOI: 10.1136/bmjoq-2023-002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND We describe a novel process using positive deviance (PD) with the Canadian Association of Thoracic Surgeons members, to identify perioperative best practice to minimise anastomotic leak (AL) and length of stay (LOS) following oesophagectomy. To our knowledge, this is the first National combination of level 1 evidence with expert opinion (ie, PD seminar) aimed at reducing AL and LOS in oesophageal surgery. Our primary hypothesis is that a multicentre National PD seminar is feasible, and could lead to the generation of best practices recommendations aimed at reducing AL and LOS in patients with oesophageal cancer. METHODS Adverse events, LOS and AL incidence/severity following oesophagectomy were prospectively collected from seven Canadian thoracic institutions using Thoracic Morbidity and Mortality classification system (2017-2020). Anonymised display of centre's data were presented, with identification of centres demonstrating PD. Surgeons from PD sites discussed principles of care, culminating in the consensus recommendations, anonymously rated by all (5-point Likert scale). RESULTS Data from 795 esophagectomies were included, with 25 surgeons participating. Two centres were identified as having the lowest AL rates 44/395 (11.1%) (vs five centres 71/400 (17.8%) (p<0.01)) and shortest LOS 8 days 45 (IQR: 6-14) (vs 10 days (IQR: 8-18) (p<0.001)). Recommendations included preoperative (prehabilitation, smoking cessation, chemotherapy for patients with dysphagia, minimise stents/feeding tubes), intraoperative (narrow gastric conduit, intrathoracic anastomosis, avoid routine jejunostomy, use small diameter closed-suction drains), postoperative day (POD) (early (POD 2-3) enteral feeding initiation, avoid routine barium swallow studies, early removal of tubes/drains (POD 2-3)). All ranked above 80% (4/5) in agreement to implement recommendations into their practice. CONCLUSION We report the feasibility of a National multicentre PD seminar with the generation of best practice recommendations aimed at reducing AL and LOS following oesophagectomy. Further research is required to demonstrate whether National PD seminars can be an effective quality improvement tool.
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Affiliation(s)
- Daniel Jones
- Surgery, Thoracic, University of Ottawa, Ottawa, Ontario, Canada
| | - Molly Gingrich
- Surgery, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | - Caitlin Anstee
- Surgery, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | - Sara Najmeh
- Thoracic and Upper GI, McGill University, Montreal, Quebec, Canada
| | - Najib Safieddine
- Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gail Darling
- Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christian Finley
- Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Daniel G French
- Thoracic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorenzo Ferri
- Thoracic and Upper GI, McGill University, Montreal, Quebec, Canada
| | - Andrew Seely
- Surgery, Thoracic, University of Ottawa, Ottawa, Ontario, Canada
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Seely AJE, Ahmadzai Z, French DG, Gingrich M, Jones D, Anstee C, Safieddine N, Waddell TK, Malthaner R, Ferri L, Finley C, Darling G. Multicentre positive deviance to reduce adverse events and length of stay after pulmonary resection. BMJ Open Qual 2023; 12:e001997. [PMID: 36669834 PMCID: PMC9872471 DOI: 10.1136/bmjoq-2022-001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Postoperative adverse events (AEs) following pulmonary resection enormously impact patient well-being, length of stay (LOS) and healthcare costs. Standardised AE data collection can be used to identify positive outliers demonstrating positive deviance (PD) who may be helpful to inform the best practice. Here, we describe our initial experience of a novel quality improvement process using PD to reduce LOS and AEs. METHODS AE rates and LOS were collected from four centres (2014-2020) using a common dictionary. Surgeons repeatedly participated in 60 to 90 min seminars consisting of the following process: identify outcome and procedure targeted, review relevant best evidence literature, view all data anonymised by surgeon or centre (if multicentre), choose and reveal identity of best performance PD outliers, who discuss their management principles while all receive self-evaluation reports, followed by collegial discussion to generate consensus recommendations, voted by all. We assessed overall impact on AEs and LOS using aggregate data in a before/after analysis. RESULTS A total of 131 surgeons (average 12/seminar) participated in 11 PD seminars (8 local and 3 multicentre), yielding 85 consensus recommendation (average 8/seminar). Median LOS following lobectomy decreased from 4.0 to 3.0 days (p=0.04) following local PD seminars and from 4.0 to 3.5 days (p=0.11) following multicentre seminars. Trends for reductions in multiple AE rates were also observed. CONCLUSION While limited by the longitudinal design, these findings provide preliminary support for this data-driven, collegial and actionable quality improvement process to help standardise and improve patient care, and merits further more rigorous investigation.
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Affiliation(s)
- Andrew J E Seely
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Daniel G French
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Molly Gingrich
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel Jones
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Caitlin Anstee
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Najib Safieddine
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Gail Darling
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Popescu I. Measuring and Improving Patient Safety in Canada. PATIENT SAFETY 2022. [DOI: 10.33940/med/2022.9.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patients, families, and care providers affected by patient safety incidents expect there
will be learning and improvement so that others will not suffer. For that, countries need mature data systems and a culture of safety that includes improving by learning from reporting hazards, harm, and near misses, as well as learning from situations and organizations where safe care is delivered consistently over time, which is in most cases.
While systems are in place to support incident reporting, sharing, and learning from a variety of sources, in Canada truly national incident reporting is limited to medications, adverse drug reactions, and device failures. However, there are other pan-Canadian and
grassroots efforts to advance reporting and learning from patient safety incidents that are complementary. System and contextual factors influence the ability to improve safety, learn, and report. An important one is the COVID-19 pandemic, which resulted in limited or delayed patient safety reporting and some scaling back of improvement projects.
The best systems incorporate reporting from multiple sources (patient feedback, coroner reports, etc.) and engage all people involved in care, especially patients and families, in their design, implementation, and continuous improvement. Patient groups,
like Patients for Patient Safety Canada (PFPSC), provide the perspective of patients and families with lived experiences that can effectively improve safety. PFPSC contributes to the development of Canadian patient safety strategies, policies, and programs, and innovates and co-leads initiatives that matter to patients and the public.
The World Health Organization’s Global Patient Safety Action Plan includes patient safety incident reporting and learning systems to “ensure a constant flow of information and knowledge to drive the mitigation of risk, a reduction in levels of avoidable harm, and improvements in the safety of care” objective.
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Gartner JB, Lemaire C. Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review. Int J Health Plann Manage 2022; 37:1941-1952. [PMID: 35288968 DOI: 10.1002/hpm.3452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/23/2021] [Accepted: 02/12/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address. METHODS A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses. RESULTS We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted. CONCLUSION Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Célia Lemaire
- Université de Strasbourg, EM Strasbourg-Business School, HuManiS, Strasbourg, Alsace, France
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Quality improvement in pediatric nephrology-a practical guide. Pediatr Nephrol 2020; 35:199-211. [PMID: 30612204 DOI: 10.1007/s00467-018-4175-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/16/2022]
Abstract
Improving quality of care delivery is an important focus for all practicing physicians. Frontline clinicians are in a great position to identify clinical problems and find innovative solutions. The current review describes the method used for quality improvement based on the Model for Improvement, a structural framework to guide improvement work. At its basis are three fundamental questions: What are we trying to accomplish? How will I know that a change will lead to improvement? And what changes could we make that will result in improvement? This preparation phase aims to identify and understand the problem, choose an intervention, and determine reliable measures to gauge improvement. The intervention is then tested using PLAN-DO-STUDY-ACT (PDSA) cycles, an iterative approach to systematically improve processes and outcomes. PLAN focuses on defining the goal of the cycle and describing in details what will be done. DO concentrates on the concrete application of the plan. STUDY focuses on data analyses as ACT identifies lessons learned from the cycle and orientate the goals of the following PDSA cycle. Learning from each cycle, developing an interdisciplinary team and repeated interventions are core principles involved in implementing a sustainable quality improvement program. The Model for Improvement will be illustrated by a common quality problem in pediatric nephrology.
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Abate D, Aman MA, Nasir BB, Gebremariam GT, Fentie AM. Assessment of Quality of Care Using Information on Patient Satisfaction at Adult Oncology Center of Tikur Anbessa Specialized Hospital, Ethiopia: A Cross-Sectional Study. Patient Prefer Adherence 2020; 14:847-858. [PMID: 32546979 PMCID: PMC7247603 DOI: 10.2147/ppa.s253027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of morbidity and mortality in the world. It results in considerable mental, physical, and emotional stress for patients. Because of the nature and impact of the disease, and its treatment, measurements of patient satisfaction are important to bring to the attention of health-care providers in order to improve care. OBJECTIVE To assess patient satisfaction at the adult oncology center of Tikur Anbessa Specialized Hospital, Ethiopia using the EORTC PATSAT-C33 tool. METHODS A facility-based cross-sectional study was conducted from January 2019 to May 2019. A consecutive sampling technique was employed to recruit a total of 384 study participants. Informed consent was obtained for each participant and data were collected using an interviewer-administered questionnaire. Ethical clearance and approval of the study protocol were obtained from the institutional ethics review board of the school of pharmacy. Descriptive statistics was used to summarize the data, while multivariate linear regression analysis was employed to explore factors affecting patient satisfaction. P<0.05 was considered as statistically significant. RESULTS Among a total of 384 study participants, the majority were female (65.9%) and the median age was 49 years. In most (65.9%) participants, the health-care service cost was covered by patients themselves; the majority of them were treated for gynecological malignancy (37.2%) and most received chemotherapy + surgery (37.2%). The mean score for the EORTC-PATSAT33 scales for overall satisfaction was 44.8 out of 100. Place of residence, gender, type of cancer, duration since treatment started, age and source of health-care costs were factors associated with patient satisfaction and all together explained 83% (adjusted R square=0.830, P<0.0001) of variance. Of these, residence (where patients came from) accounted for most (78.7%) of the variance (adjusted R square=0.787, P<0.0001). CONCLUSION The mean overall satisfaction of patients with the services provided at the outpatient adult oncology center of TASH was significantly lower than previously reported in the world literature, which was >70. Hence, a concerted effort must be made to understand and improve patient satisfaction in oncology health-care services in Ethiopia.
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Affiliation(s)
- Dessale Abate
- Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Munir Awol Aman
- Tikur Anbessa Specialized Hospital, Adult Oncology Center, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beshir Bedru Nasir
- Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Tekle Gebremariam
- Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Atalay Mulu Fentie PO Box: 1176Tel +251923295462 Email
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Eubank BHF, Lafave MR, Preston Wiley J, Sheps DM, Bois AJ, Mohtadi NG. Evaluating quality of care for patients with rotator cuff disorders. BMC Health Serv Res 2018; 18:569. [PMID: 30029658 PMCID: PMC6053822 DOI: 10.1186/s12913-018-3375-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background Measuring quality in healthcare is vital in evaluating patient outcomes and system performance. The availability of reliable and valid information about the quality of care for patients presenting with rotator cuff disorders (RCD) in Alberta, Canada is scarce. The objective of this study is to measure quality of care for patients with RCD in order to identify areas of improvement. Methods This study employs descriptive survey research design. Between March 2015 and November 2016, a convenience sample of patients presenting with chronic, full-thickness rotator cuff tears to two sport medicine centres in Calgary and Edmonton, Alberta completed two questionnaires: the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) and the Rotator Cuff Quality-of-Life Index (RC-QOL). Data collected using both questionnaires were used to make judgments about quality of care. Quality of care was evaluated using six dimensions of quality defined by the Alberta Quality Matrix for Health: accessibility, acceptability, efficiency, effectiveness, appropriateness, and safety. Data was also used to compare current patient clinical pathways to ideal clinical pathway algorithms and used to make judgments about the appropriateness and safety of healthcare practices. Results One hundred seventy-one patients participated in the study. The longest mean waiting times for medical services in Alberta were for magnetic resonance imaging (MRI) received in the public sector (103 days) and consultation by orthopaedic surgeon (172 days). Patient satisfaction with respect to quality of care was lowest for emergency room physician and highest for orthopaedic surgeon visits. Patients were treated by a mean of 2.5 physicians (SD: 0.77, range: 2–7). The total aggregate average cost per patient was $4541.19. The mean RC-QOL score for all patients was 42 (SD: 22). Only 54 patients (64%) requiring surgery were able to consult with a surgeon within benchmark timeframes. A comparison of current to ideal clinical pathway algorithms found that 38 patients (22%) experienced indirect clinical pathways, whereby care was fragmented and patients received care from multiple and often, redundant healthcare professionals. Conclusion There is a discrepancy between current and ideal clinical pathways whereby some patients are experiencing quality of care that is inefficient, disjointed, and less than ideal.
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Affiliation(s)
- Breda H F Eubank
- Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada.
| | - Mark R Lafave
- Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada
| | - J Preston Wiley
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - David M Sheps
- Division of Orthopaedics, Department of Surgery, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, T6G 2R3, Canada
| | - Aaron J Bois
- Division of Shoulder and Elbow Surgery, Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Nicholas G Mohtadi
- Sport Medicine Centre , Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Xiong J, He Z, Deng Y, Zhang M, Zhang Z. Quality management practices and their effects on the performance of public hospitals. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2017. [DOI: 10.1108/ijqss-02-2017-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
To face profound changes from decreasing funding, growing patient expectations and increasing competition in the health-care market, public hospitals began to implement effective quality management (QM) practices following manufacturing and other service industries. However, there was little knowledge relevant to the impact of QM practices on the performance of public hospitals. The study aims to shed some further light on this issue.
Design/methodology/approach
The paper extends the previous empirical research to the health-care sectors and suggests the research framework of QM practice-performance relationships in public hospitals. For validation purposes, a cross-sectional survey involving 204 quality managers and directors of large public hospitals was carried out between April and October 2013 in Zhejiang Province, China. Structural equation modeling was used to test the hypothesized relationship between QM practices and hospital performance.
Findings
Empirical results support that the implementation of QM practices can bring many benefits to sample hospitals. The dimensions of employee relations and process management are directly related to the health-care and non-health-care performance of public hospitals.
Originality/value
It explores the relationship between QM practices and hospital performance based on empirical results from Chinese public hospitals, whereas few studies have been conducted within the context of public health-care sectors in developing countries. The empirical results could enhance hospital managers’ understanding of the nature of QM practice-performance relationship and help mangers re-allocate more resources to those elements of the QM systems that have the most significant impact on hospital performance.
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