Quality Health Care

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Qual Health Care 2001;10:40-48 doi:10.1136/qhc.10.1.40
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Management matters: the link between hospital organisation and quality of patient care 1. Elizabeth West, senior research fellow
+ Author Affiliations
1. Royal College of Nursing, Radcliffe Infirmary, Woodstock Road, Oxford OX1 6HE, UK 1. Dr E West elizabeth.west@rcn.org.uk
* Accepted 21 December 2000
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Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that “management matters”, as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically. A larger, and arguably more rigorous, body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Studies in these traditions have focused on the effects of decentralisation, participation, innovative work practices, and “complementarities” on outcome variables such as job satisfaction and performance. The aim of this paper is to identify a number of reviews and research traditions that might bring new ideas into future work on the determinants of hospital performance. Ideally, future research should be more theoretically informed and should use longitudinal rather than cross sectional research designs. The use of statistical methods such as multilevel modelling, which allow for the inclusion of variables at different levels of analysis, would enable estimation of the separate contribution that structure and process make to hospital outcomes. * hospital organisation

* hospital performance
* management
* quality of care
Key messages
* Studies linking the organisation and management of health care to patient and staff outcomes, mainly conducted in the USA, can be criticised both theoretically and methodologically. * There are currently no high quality studies of these relationships in the UK. * This paper identifies key review articles of studies, both in health care and in business, that might throw new light on the determinants of hospital performance. * Research on the performance of business firms suggests the importance of decentralised decision making, staff participation and involvement, innovative work practices, and the “fit” between structure, strategy, and environment. * Future research could be improved by greater attention to the mechanisms that might plausibly link, for example, staff variables to patient outcomes by adopting longitudinal rather than cross sectional research designs and by using appropriate statistical methods such as multilevel modelling. Previous SectionNext Section

Organisational researchers have long sought to establish the impact of organisational structures and managerial processes on outcomes such as profitability,1 effectiveness,2 performance,3 and organisational growth and survival.4 Organisational researchers have also focused on the public sector, particularly hospitals, in an effort to link organisational characteristics to a number of important outcomes for patients and staff.56 Although few would now question that “management matters” in delivering quality health care, knowledge about the nature of the relationship is incomplete. The fact that we know so little about the relationship between structures, processes, and outcomes within hospitals makes it difficult to recommend, on the basis of sound theory and empirical evidence, ways of organising that could improve patient care. One of the criticisms of research on hospital performance is that it has been rather insular, paying little attention to developments in related fields such as organisational sociology, organisational...
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