Organization design and performance: An investigation of the hospital quality management function.

Abstract

This study utilized a cross-sectional survey to investigate differences in the design and performance of the quality management function among non-federal, non-state short-term acute care general hospitals in Michigan. The measures for hospital performance included productivity, quality, based on the hospitals' confirmed problem rates, and performance measured as two composites of hospitals' productivity and quality. Four hypotheses were investigated. For the first, significant differences were found in the quality and performance of hospitals having different general design combinations for the quality management function among (1) separate quality management departments, (2) combinations of the quality management departments, and (3) combinations of the quality management departments with non-quality management areas. Specifically, having a separate quality management area(s) was significantly related to better quality and performance. The investigation of the second hypothesis did not reveal any significant differences in the overall performance of hospitals having different general designs for the quality improvement initiative. The third hypothesis addressed the differences in the overall performance of hospitals using different specific design characteristics of the quality management function related to the management hierarchy, integrative groups, and staffing and specialization. While the set of specific design characteristics was moderately significant for productivity and weakly significant for quality and both performance measures, the results were equivocal since few of the individual specific design characteristics were significant. Among the specific design characteristics, having greater intensity of supervision was significantly associated with poorer productivity and performance. This finding suggests that, since the quality management function is generally composed of professionals, wide spans of control and minimal supervision can be employed. Having more personnel categories was found to be significantly associated with poorer productivity, and having more committees associated with higher performance. The fourth hypothesis considered a variety of control measures which were also of conceptual interest: having a medical staff manager, using a board quality committee, location and teaching status, nurse executive education, and accreditation source. The most consistent results were support for having a part-time medical staff manager under age sixty, and accreditation by the American Osteopathic Association. Overall, the study provides some support for concluding that the design of the quality management function affects performance. The methodological contribution of this study stems for its breadth in consideration of hospital design (structure) characteristics, and the development of measures to explore the links with performance (outcome).