Pfaff Holger, Hammer Antje, Ballester Marta, Schubin Kristina, Swora Michael, Sunol Rosa
Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany.
Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain.
BMC Health Serv Res. 2021 Jan 19;21(1):70. doi: 10.1186/s12913-020-06053-0.
The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of hospital boards using Talcott Parsons' sociological concept of adaptation, goal attainment, integration, and latency (AGIL), focusing on the G (goal attainment) and I (integration) factors of this concept. The study aims to test the hypothesis that hospitals with management boards that are oriented toward the quality goal (G) and socially integrated (I) (GI boards) are better at implementing quality management than hospitals with boards lacking these characteristics (non-GI boards).
A cross-sectional mixed-method design was used for data collection in 109 randomly selected hospitals in seven European countries. Data is based on the study "Deepening our understanding of quality improvement in Europe" (DUQUE). We used responses from (a) hospitals' chief executive officers to measure the variable social integration and the variable quality orientation of the board and (b) responses from quality managers to measure the degree of implementation of the quality management system. We developed the GI index measuring the combination of goal-orientation and integration. A multiple linear regression analysis was performed.
Hospitals with management boards that are quality oriented and socially integrated (GI boards) had significantly higher scores on the quality management system index than hospitals with boards scoring low on these features, when controlled for several context factors.
Our findings suggest that the implementation power of hospital management boards is higher if there is a sense of unity and purpose within the boards. Thus, to improve quality management, it could be worthwhile to increase boards' social capital and to increase time designated for quality management in board meetings.
实施研究的综合框架指出，个人领导力在质量管理实施中至关重要。然而，医院管理委员会中的多元领导力的哪些特征使其具有影响力仍有待解答。本研究使用塔尔科特·帕森斯的社会学适应、目标达成、整合和潜在模式维持（AGIL）概念，聚焦于医院委员会实施权力的社会决定因素，重点关注该概念的G（目标达成）和I（整合）因素。该研究旨在检验以下假设：与缺乏这些特征的委员会的医院（非GI委员会）相比，具有以质量目标为导向（G）且社会整合（I）的管理委员会的医院（GI委员会）在实施质量管理方面表现更好。
采用横断面混合方法设计，对七个欧洲国家随机选取的109家医院进行数据收集。数据基于“深化我们对欧洲质量改进的理解”（DUQUE）研究。我们使用了（a）医院首席执行官的回复来衡量委员会的社会整合变量和质量导向变量，以及（b）质量经理的回复来衡量质量管理体系的实施程度。我们开发了衡量目标导向和整合相结合的GI指数。进行了多元线性回归分析。
在控制了几个背景因素后，具有质量导向且社会整合的管理委员会的医院（GI委员会）在质量管理体系指数上的得分显著高于在这些特征上得分较低的委员会的医院。
我们的研究结果表明，如果委员会内部存在团结感和目标感，医院管理委员会的实施权力会更高。因此，为了提高质量管理，增加委员会的社会资本以及在董事会会议中增加指定用于质量管理的时间可能是值得的。
