Abstract
ObjectivesTo review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care.DesignA systematic review of the literature.MethodsA search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15 447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles.ResultsThe majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals.ConclusionsThere is some evidence that managers’ time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance.
Highlights
Managers in healthcare have a legal and moral obligation to ensure a high quality of patient care and to strive to improve care
Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee
There is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken
Summary
Managers in healthcare have a legal and moral obligation to ensure a high quality of patient care and to strive to improve care. These managers are in a prime position to mandate policy, systems, procedures and organisational climates. ▪ This is the first systematic review of the literature that has considered the evidence on Boards’ and managers’ time spent, engagement and work within the context of quality and safety. ▪ The review reveals conditions and actions conducive to good quality management and offers a model to transparently present these to managers considering their own part in quality and safety. To add to the momentum are some high profile publicity of hospital management failures affecting quality and safety, eliciting strong instruction for managerial leadership for quality at the national level in some countries.[7 8]
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