Abstract
ObjectiveThe aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries.DesignQuestionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument.Setting and participantsAs part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents.Main Outcome MeasureThe extent of implementation of QMSs.ResultsFactor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27.ConclusionAssessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement.
Highlights
In a recent review on instruments assessing the implementation of quality management systems (QMSs) in hospitals, the authors conclude that hospital managers and purchasers would benefit from a measure to assess the implementation of QMS in Europe
The aim of the questionnaire was to focus on the managerial aspects of quality management such as policy documents, formal protocols, analyzing performance and evaluating results, and not on leadership, professional and patient involvement or organizational culture, as these are different theoretical concepts within the Deepening our Understanding of Quality improvement in Europe (DUQuE) framework (Fig. 1) and which are assumed to influence the implementation of QMS
Quality managers of all the hospitals responded to the questionnaire, but five quality managers provided not enough data to calculate the nine scales and the Quality Management Systems Index (QMSI)
Summary
In a recent review on instruments assessing the implementation of quality management systems (QMSs) in hospitals, the authors conclude that hospital managers and purchasers would benefit from a measure to assess the implementation of QMS in Europe. The results of the review show that there is currently no well-established measure that has be used to assess the link between quality management at hospital level, quality management activities at departmental level and patient outcomes [1]. 18 studies to assess the implementation of QMSs have been described. Nine of these studies reported methodological criteria in sufficient detail and were
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