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Quality Improvement Implementation and Hospital Performance on Patient Safety Indicators

University of North Carolina at Chapel Hill

Jeffrey A. Alexander

University of Michigan, Ann Arbor

Laurence C. Baker

Stanford University

Stephen M. Shortell

University of California, Berkeley

Mark Becker

University of Minnesota at Minneapolis

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions'Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators. Involvement by multiple hospital units in the QI effort is associated with worse values on all four patient safety indicators. Percentages of hospital staff and of senior managers participating in QI teams exhibited no statistically significant association with any patient safety indicator. Percentage of physicians participating in QI teams is associated with better values on two patient safety indicators.

Key Words: quality improvement • implementation • patient safety • medical errors

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