Medical Care Research and Review

 

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This version was published on June 1, 2008
Medical Care Research and Review, Vol. 65, No. 3, 259-299 (2008)
DOI: 10.1177/1077558707309613

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Review: How Do Hospital Organizational Structure and Processes Affect Quality of Care?

A Critical Review of Research Methods

Larry R. Hearld

University of Michigan School of Public Health, Ann Arbor

Jeffrey A. Alexander

University of Michigan School of Public Health, Ann Arbor

Irene Fraser

Agency for Healthcare Research and Quality, Rockville, Maryland

H. Joanna Jiang

Agency for Healthcare Research and Quality, Rockville, Maryland

Interest in organizational contributions to the delivery of care has risen significantly in recent years. A challenge facing researchers, practitioners, and policy makers is identifying ways to improve care by improving the organizations that provide this care, given the complexity of health care organizations and the role organizations play in influencing systems of care. This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure—process—outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure—quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care.

Key Words: hospital • quality of care • organizational factors • research methods


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