This article identifies areas of management research that should be pursued to develop a better understanding of barriers and facilitators to improve quality in health care organizations. Five major structural barriers to improvement of quality are discussed. Research priorities are presented with suggestions on how to encourage more meaningful research that will accelerate quality improvement in health care.
The focus of this paper is to identify the areas of management research that should be pursued to develop a better understanding of barriers and facilitators and to improve quality in health care organizations. It begins by presenting the current status of quality within health care, followed by five major structural barriers to the improvement of quality in a health care delivery organization. It cites not only the experience documented in health care literature, but the experience from the perspective of an integrated health care delivery organization. An organizational framework presented by Berwick,1 and a framework for performance improvement by Nolan (Nolan, T. Personal communication) are used to discuss research priorities in health care quality improvement. The article concludes with some observations as to how to encourage more meaningful research that would accelerate quality improvement in health care.
This article is based heavily on over 20 years experience at Henry Ford Health System (HFHS), a major integrated health care system located in Detroit, MI, and the author's experience as a consultant and a board member of a number of health care delivery organizations. HFHS consists of a 900-bed teaching institution located in downtown Detroit with more than 800 physicians in training, a research budget exceeding US$50 million, five community hospitals, a multispecialty group with 1,000 physicians practicing in over 30 ambulatory care centers, a wholly owned health care insurance company with more than 600,000 members, and related health care businesses including home health care, home medical equipment, a network of dialysis centers, over 30 optical centers, nursing homes, and a hospice. HFHS has an annual budget of US$2.5 billion and employs 16,000 staff.
Finally, for the past 12 years, as a founding board member of the Institute for Healthcare Improvement (IHI), the author has had the privilege of sharing ideas on quality improvement with a number of dedicated and brilliant individuals from the health care industry. The comments in this paper should not be construed as the official position of leadership of HFHS or IHI, but observations of the author.
Vinod K. Sahney, Ph.D., is Senior Vice President, Planning and Strategic Development, Henry Ford Health System, Detroit, Michigan. E-mail: firstname.lastname@example.org.
In preparation for this paper I had discussions with a number of practitioners and researchers. I also received helpful comments on an earlier version from a number of colleagues. My sincere thanks to: Paul Batalden, M.D., James W. Begun, Ph.D., William Conway, M.D., Robert Crane, M.D., Jennifer Elston Lafata, Ph.D., Ellen Gaucher, MSN, David Gustafson, Ph.D., Rose Glenn, Mark Kelley, M.D., Anthony Kovener, Ph.D., David Leach, M.D., Louise Liang, M.D., Gene Nelson, Ph.D., David Nerenz, Ph.D., Thomas Nolan, Ph.D., Manel Pladevall, M.D., Jonathan Schwartz, M.D., Patricia Stoltz, and Robert Waller, M.D.