Antje Hammer

The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals

Objective To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Setting and Participants Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measure Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Results Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Conclusions Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M)

BackgroundFrom a management perspective, it is necessary to examine how a hospitals top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M) has the same psychometric properties as the HSOPS for hospital employees does.MethodsIn 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA). Additionally, we proved construct validity and internal consistency.ResultsA total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbachs alpha indicated that the dimensions had an acceptable level of reliability.ConclusionThe analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital managements points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.

The associations between organizational culture, organizational structure and quality management in European hospitals

Objective To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. Design A multi-method, multi-level, cross-sectional observational study. Setting and participants As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Main outcome measures Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Results Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. Conclusion The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.

Quality management and perceptions of teamwork and safety climate in European hospitals

OBJECTIVE This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. METHOD We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. SETTING AND PARTICIPANTS Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. MAIN OUTCOME MEASURES Perceived teamwork and safety climate. RESULTS Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. CONCLUSIONS Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.

Is social capital as perceived by the medical director associated with coordination among hospital staff? A nationwide survey in German hospitals

Effective coordination among all members of hospital staff has been shown to be associated with better quality of care. The literature indicates that social capital, a form of organizational resource, may facilitate the task of coordination. However, to the best of our knowledge, no study has yet examined this link within a healthcare setting. Thus, the objective of this study was to analyze the relationship between social capital and coordination among hospital staff, as perceived by the medical director being a key informant of the hospital. In 2008, we surveyed the medical directors of 1224 German hospitals by the use of a standardized questionnaire. We conducted stepwise multivariate linear regression and controlled for hospital size, ownership and teaching status. In total, 551 medical directors (45%) responded to the survey. We found social capital to be a significant predictor of coordination (β = 0.444, p < 0.001). The regression model explained 28% of the variance in coordination. Higher levels of social capital can be associated with better coordination among members of hospital staff, as perceived by the medical director. Therefore, investment in social capital may facilitate better organization of work processes in hospitals and may therefore help to improve patient outcomes. However, longitudinal studies are needed in order to explain the causal relationship between social capital and coordination among hospital staff.

The relationship between social capital and quality management systems in European hospitals: a quantitative study.

Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.

The association between transformational leadership in German hospitals and the frequency of events reported as perceived by medical directors

This paper aimed to evaluate how transformational leadership behaviour is associated with patient safety culture in a hospital context. In line with findings from other high-hazard industries, we predicted that in hospitals, executives’ perceived emphasis on transformational behaviour would positively influence the frequency of events reported by staff on the front line of service provision. Our hypothesis was confirmed by fitting a multivariable regression model to a sample of 507 medical directors of German acute-care hospitals. Results revealed transformational leadership in hospitals was a significant predictor of the reporting frequency of safety events, as perceived by medical directors. Our findings highlighted the critical role that executive behaviour plays in staff participation in patient safety initiatives. Preventing patients from unintended harm can then be traced back to the organisational level that is the farthest away from direct patient interaction. Consequently, these findings may provide guidance for hospitals aiming to raise employees’ awareness of patient safety and prevent unintended patient harm prospectively.

THE IMPACT OF SOCIAL CAPITAL ON QUALITY MANAGEMENT SYSTEMS IN EUROPEAN HOSPITALS

Introduction Previous empirical studies found that strategic leadership is an important organizational capability, and is essential for quality and safety improvement in hospital settings. Moreover, the quality of leadership depends crucially on a common set of shared values and relationships of mutual trust among hospital management board members. In accordance with the concept of social capital these are essential requirements for successful cooperation and coordination within groups. We therefore hypothesize that the degree of social capital within the hospital management boards is associated with the effectiveness and maturity of quality management system in European hospitals. Methods For analysing the presumed relationship, we used data from the EU funded project “Deepening our understanding of quality improvement in Europe (DUQuE)”. Within the study we used a mixed-method approach to data collection and measurement in 188 hospitals of the 7 European countries Czech Republic, Germany, France, Poland, Portugal, Spain, and Turkey. The exposure social capital was measured with a six-item scale incorporated into the chief executive officers (CEO) questionnaires. CEOs have been asked about their perceptions of social capital within the hospital management board. The outcome quality management system at the hospital level (QMSH) is a newly developed index, which consist of 46 items and 9 scales measuring a range of criteria related to quality improvement. The items were incorporated into the questionnaire for the quality manager (QM). In order to test the hypothesis, we conducted a multilevel linear regression model. We controlled for hospital ownership, number of beds, organizational culture, and the number of hospital board members. The country where the hospital is based was considered as confounder at the country level. Results The average social capital score within the hospitals was 3.3 (standard deviation: 0.5; range: 1–4). The average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0–27). Higher social capital was associated with higher quality management system index scores (regression coefficient: 1.42; standard error: 0.64, p=0.029). Discussion The results indicated a strong correlation between the exposure and the outcome variable. Social capital in hospital (management) boards positively influences quality management systems in European hospitals. For practical implication, the results indicate a potential advantage of strengthening the existing social capital in hospital management boards, perhaps by building trust through personal development courses or further education on teamwork within the hospital management board. Within the presentation results will be discussed in light of strengths (e.G. multi method approach) and limitations (e.G. cross-sectional design) of the study. Declaration of competing interests This project has been funded by the European Commissions Seventh Framework Programme FP7/2007–2013 under grant agreement number 24188.

Interorganizational relationships and hospital financial performance: a resource-based perspective

This study follows a resource-based theory perspective and aims to analyze the interorganizational relationships between hospitals and outpatient physicians, and hospital financial performance. In the light of increasing interdependence among healthcare providers which has made the coordination of service provision more complex, such relationships could be considered a resource for hospitals that lead to higher performance. In this study, the results from a survey of medical directors were combined with financial performance indicators of their hospitals. The results show that having effective interorganizational relationships is positively associated with the hospitals profitability. This finding emphasizes the importance of an investment in interorganizational relationships from the hospitals point of view.

Do Occupational and Patient Safety Culture in Hospitals Share Predictors in the Field of Psychosocial Working Conditions? Findings from a Cross-Sectional Study in German University Hospitals

Background: In the healthcare sector, a comprehensive safety culture includes both patient care-related and occupational aspects. In recent years, healthcare studies have demonstrated diverse relationships between aspects of psychosocial working conditions, occupational, and patient safety culture. The aim of this study was to consider and test relevant predictors for staff’s perceptions of occupational and patient safety cultures in hospitals and whether there are shared predictors. From two German university hospitals, 381 physicians and 567 nurses completed a questionnaire on psychosocial working conditions, occupational, and patient safety culture. Two regression models with predictors for occupational and patient safety culture were conceptually developed and empirically tested. In the Occupational Safety Culture model, job satisfaction (β = 0.26, p ≤ 0.001), work‒privacy conflict (β = −0.19, p ≤ 0.001), and patient-related burnout (β = −0.20, p ≤ 0.001) were identified as central predictors. Important predictors in the Patient Safety Culture model were management support for patient safety (β = 0.24, p ≤ 0.001), supervisor support for patient safety (β = 0.18, p ≤ 0.001), and staffing (β = 0.21, p ≤ 0.001). The two models mainly resulted in different predictors. However, job satisfaction and leadership seem to play an important role in both models and can be used in the development of a comprehensive management of occupational and patient safety culture.