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International Journal for Quality in Health Care Advance Access originally published online on October 18, 2007
International Journal for Quality in Health Care 2007 19(6):341-348; doi:10.1093/intqhc/mzm047
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

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

Seth W. Glickman1,2, Kelvin A. Baggett1,3, Christopher G. Krubert2, Eric D. Peterson1 and Kevin A. Schulman1

1 Duke University, Durham, North Carolina, USA
2 ApolloMD Emergency Services, Atlanta, Georgia, USA

Background. 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.

Issue. 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.

Solutions. 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.

Keywords: outcome and process assessment (health care), quality assurance (health care), quality indicators (health care)

* Address reprint requests to: Kevin A. Schulman; E-mail: kevin.schulman{at}duke.edu

3 Present address: HCA Inc., Nashville, Tennessee, USA.

Accepted for publication August 17, 2007.


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