Process quality improvement: An examination of general vs. outcome-specific climate and practices in hospitals

Despite numerous efforts to foster quality improvement in healthcare, much of the extant data and research indicate that substantial shortcomings in the delivery of effective and reliable care remain. This research examines both general and outcome-specific operations management efforts and their impact on delivering quality healthcare. We empirically test a conceptual framework of safety culture that accounts for the use of general quality practices as well as outcome-specific approaches in light of the general and more focused climates in which those practices are embedded. We utilize structural equation modeling to analyze a unique pairing of primary data from a survey of quality improvement directors and chief nursing officers at 272 hospitals across the U.S. with secondary data on process of care performance publicly reported by the federal government's Center for Medicare and Medicaid Services (CMS). General safety climate and quality practices are found to establish an environment in which outcome-specific efforts enable process quality improvement. A split-group SEM analysis highlights significant differences in managing healthcare safety outcomes through climate and practices. In particular, the employment of practices focused on the specific outcome goals is found to relate to higher quality of patient care in smaller hospitals. In contrast, the development of a climate focused on specific outcome goals is found to relate to higher quality of patient care in larger hospitals. These findings suggest alternative approaches for small and large hospitals in the critical effort to improve patient safety and reduce healthcare costs.