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Engagement of Leadership in Quality Improvement Initiatives: Executive Quality Improvement Survey Results

Vaughn, Thomas PhD, MHSA*†; Koepke, Mark JD, MHA; Kroch, Eugene PhD§; Lehrman, William PhD; Sinha, Sunil MD, MBA; Levey, Samuel PhD, SM

Journal of Patient Safety: March 2006 - Volume 2 - Issue 1 - p 2-9
Original Articles

Objectives: Identify characteristics of hospital leadership engagement in quality improvement that are most likely to strengthen quality improvement activities within hospitals.

Methods: The University of Iowa coordinated the administration of a hospital quality improvement (QI) and leadership short survey to chief executive officers and senior quality executives from a sample of hospitals in 8 states.

Results: Better quality index scores are associated with hospitals where the board (1) spends more than 25% of their time on quality issues, (2) receives a formal quality performance measurement report, (3) bases the senior executives' compensation in part on QI performance, and (4) engages in a high level of interaction with the medical staff on quality strategy. Better quality index scores are also associated with the chief executive officer being identified as the person with the greatest impact on QI, especially when identified as such by the QI executives.

Conclusions: The results of the survey show that hospital leadership is engaged in quality, but in a manner that can be enhanced. Several changes in leadership structures and systems relating to boards and senior administrative management teams are recommended so that the QI that is desired by all Americans can be realized in the hospital industry.

From the *Iowa City Veterans Integrated Health System; †The University of Iowa College of Public Health, Iowa City, Iowa; ‡Centers for Medicare and Medicaid Services, Baltimore, Maryland; and §CareScience and the Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Vaughn is a Senior Research Scientist in the Center for Research on the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Iowa City VA Health Care System, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Correspondence: Thomas E. Vaughn, PhD, MHSA, E230 GH, The University of Iowa, Iowa City, IA 52242. (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.