Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals : A quantitative analysis

This study was part of the 'Deepening our Understanding of Quality improvement in Europe (DUQuE)' project, funded by the EU 7th Research Framework Program [26]. Its aims and methods are described elsewhere [27]. The study used a multi-method, cross-sectional design to collect quality-related information from European hospitals between May 2011 and February 2012 [27]. Seven countries were included based on a mix of health and hospital system financing and organization criteria in different geographical areas in Europe. The participating countries comprised the Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. In each country, 30 hospitals were randomly recruited, subject to them having more than 130 beds and that they treat acute myocardial infarct, hip fracture, stroke and deliveries patients [27]. The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Objective: To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. Design: A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. Participants: One hundred and fifty-five CEOs and 155 quality managers. Setting: One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s): Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Results: Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP d