Promoting quality: the health-care organization from a management perspective.

Published

Journal Article

Although agreement about the need for quality improvement in health care is almost universal, the means of achieving effective improvement in overall care is not well understood. Avedis Donabedian developed the structure-process-outcome framework in which to think about quality-improvement efforts.There is now a robust evidence-base in the quality-improvement literature on process and outcomes, but structure has received considerably less attention. The health-care field would benefit from expanding the current interpretation of structure to include broader perspectives on organizational attributes as primary determinants of process change and quality improvement.We highlight and discuss the following key elements of organizational attributes from a management perspective: (i) executive management, including senior leadership and board responsibilities (ii) culture, (iii) organizational design, (iv) incentive structures and (v) information management and technology. We discuss the relevant contributions from the business and medical literature for each element, and provide this framework as a roadmap for future research in an effort to develop the optimal definition of 'structure' for transforming quality-improvement initiatives.

Full Text

Duke Authors

Cited Authors

  • Glickman, SW; Baggett, KA; Krubert, CG; Peterson, ED; Schulman, KA

Published Date

  • December 2007

Published In

Volume / Issue

  • 19 / 6

Start / End Page

  • 341 - 348

PubMed ID

  • 17947386

Pubmed Central ID

  • 17947386

Electronic International Standard Serial Number (EISSN)

  • 1464-3677

International Standard Serial Number (ISSN)

  • 1353-4505

Digital Object Identifier (DOI)

  • 10.1093/intqhc/mzm047

Language

  • eng