Macinati Manuela S
Università Cattolica del Sacro Cuore, Facoltà di Economia, Largo F. Vito 1, 00168 Roma, Italy.
Health Policy. 2008 Feb;85(2):228-41. doi: 10.1016/j.healthpol.2007.07.013. Epub 2007 Sep 10.
This study aims to define the underlying factors of the quality management systems that are the best predictors of public health-care providers' organizational performance and to assess the impact of those underlying factors on performance. To reach the research objectives, a national survey involving all the Italian public health-care providers (352) was carried out. The total response rate was around 42%. The findings confirmed that the quality elements described in literature as "core values" could be considered critical factors of the quality management systems adopted by Italian health-care providers. Unlike similar studies and models currently employed by the quality award organizations, this study considered the variables related to the existence and role of the quality department. The results highlighted that this element was an important underlying factor of the quality management systems adopted by Italian health-care providers. As for the impact of the characteristics of the quality management systems on organizational performance, the results showed that the outcome subjective performance was positively related to quality management variables, but there was a lack of a significant statistical relationship between financial performance and quality management. This seems to be consistent with a health policy that, so far, has not stressed sufficiently the reinforcing effect of simultaneously pursuing quality and efficiency. A health policy that intends to reach both microeconomic efficiency and service quality, on the contrary, should promote and emphasize the synergies between these two objectives. Such a conclusion seems to be an underpinning assumption of the recent National Health Plan (2006-2008) that, finally, mentions the relationship between quality and efficiency as a way to achieve macroeconomic stabilization.
本研究旨在确定质量管理体系的潜在因素，这些因素是公共医疗服务提供者组织绩效的最佳预测指标，并评估这些潜在因素对绩效的影响。为实现研究目标，对意大利所有公共医疗服务提供者（共352家）开展了一项全国性调查。总回复率约为42%。研究结果证实，文献中描述为“核心价值观”的质量要素可被视为意大利医疗服务提供者所采用质量管理体系的关键因素。与质量奖组织目前采用的类似研究和模型不同，本研究考虑了与质量部门的存在和作用相关的变量。结果表明，这一要素是意大利医疗服务提供者所采用质量管理体系的一个重要潜在因素。至于质量管理体系特征对组织绩效的影响，结果显示，主观绩效结果与质量管理变量呈正相关，但财务绩效与质量管理之间缺乏显著的统计关系。这似乎与一项卫生政策一致，即到目前为止，该政策尚未充分强调同时追求质量和效率的强化作用。相反，一项旨在实现微观经济效率和服务质量的卫生政策应促进并强调这两个目标之间的协同作用。这样的结论似乎是近期《国家卫生计划》（2006 - 2008年）的一个基本假设，该计划最终提及质量与效率之间的关系，将其作为实现宏观经济稳定的一种方式。
