Quality improvement designs are related to the degree of organisation of quality systems: An empirical study of hospital departments

Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers

The challenges facing Quality Improvement Managers (QIMs) are often understood and addressed in isolation from wider healthcare organisation within which quality improvement initiatives are embedded. We draw on Stafford Beer's Viable System Model (VSM) to shed light on how the viability of quality improvement depends on the effective functioning of five critical quality improvement systems and the extent to which these systems are integrated within the healthcare organisation. These systems are System 1 (Operations), System 2 (Coordination), System 3 (Operational Control), System 4 (Development) and System 5 (Policy). Our analysis draws on interviews with 56 QIMs working in 15 of New Zealand's 20 District Health Boards. We use VSM to identify the sources of problems in QI implementation. These include changes in direction for QI initiatives; myopic behaviour resulting from fragmented systems of care; difficulties in managing and monitoring QI activities given variable staff engagement and inadequate resourcing; pressure for quick results rather developing QI capabilities; and a lack of strategic embeddedness. A viable QI system requires QI approaches that are (1) implemented at an organisation-wide level; (2) well-resourced and carefully monitored; (3) underpinned by a long-term vision; and (4) supported by QIMs with the necessary power and influence to integrate QI subsystem within the wider healthcare organisation.

The role of organizational culture on practising quality improvement in Jordanian public hospitals

Purpose

This study seeks to investigate empirically the impact of organizational culture (bureaucratic, innovative, and supportive) and quality improvement practices.

Design/methodology/approach

Data used in this study were obtained through a questionnaire by random sampling, which took place in four large public hospitals, located in Irbid Governorate, Jordan, involving 271 managers, physicians, and nurses.

Findings

Quality improvement practices were measured by 16 statements on a five‐point rating scale. Each of the three types of organizational culture was measured using five items on a five‐point rating scale.

Practical implications

The three types of culture have a significantly positive influence on quality improvement practices, and account for 62 per cent of the variation of quality improvement practices. Compared with bureaucratic and supportive cultures, innovative culture appears to play a stronger role in quality improvement practices. Contrary to expectations, the analysis shows that bureaucratic actions enhance rather than hinder quality improvement practices. Respondents with a bachelor or a higher degree and participating in a training course related to quality reported higher prevalence of each culture and a higher level of quality improvement practices.

Originality/value

Innovative culture has a crucial role in quality improvement practices compared with bureaucratic and supportive cultures.