Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals
| Autor: | Ernest R. Vina, Jason B. Weingarten, David C. Rhew, John T. Chang, Scott Weingarten |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Quality Assurance Health Care media_common.quotation_subject Organizational culture Efficiency Pay for performance Efficiency Organizational Cohort Studies Nursing Health care Internal Medicine Humans Medicine Quality (business) health care economics and organizations Quality of Health Care media_common business.industry Data Collection Public health Organizational Culture United States Leadership Physician Incentive Plans Incentive Models Organizational Original Article business Medicaid |
| Zdroj: | Journal of General Internal Medicine. 24:833-840 |
| ISSN: | 1525-1497 0884-8734 |
| DOI: | 10.1007/s11606-009-0997-6 |
| Popis: | The Centers for MedicareMedicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture.More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p0.01), HF (44% vs. 18%, p0.01), PN (38% vs. 13%, p0.01) and THR/TKR (56% vs. 23%, p0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p0.05) and HF (93% vs. 69%, p0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p0.05). Finally, more top performers reported having adequate human resources for QI projects (p0.01); support of the nursing staff to increase adherence to quality indicators (p0.01); and an organizational culture that supported coordination of care (p0.01), pace of change (p0.01), willingness to try new projects (p0.01), and a focus on identifying system errors rather than blaming individuals (p0.05).Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care. |
| Databáze: | OpenAIRE |
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