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Survey-Assessed Quality and Organizational Factors Related to Quality in Pursuing Perfection Hospitals

Shwartz, Michael PhD; Cramer, Irene E. PhD, MSSA; Holmes, Sally K. MBA; Cohen, Alan B. ScD; Restuccia, Joseph D. DrPH; VanDeusen Lukas, Carol EdD; Sullivan, Jennifer L. PhD; Charns, Martin P. DBA

doi: 10.1097/QMH.0b013e3181f9ef02
Original Article

Background: The goal of the Pursuing Perfection (P2) program was to encourage organizations to push quality improvement to new levels of excellence. As part of an evaluation of P2, we surveyed employees at the 7 participating P2 organizations to (1) assess their perceptions of patient care quality and improvement progress and (2) examine perceived performance on organizational and workgroup characteristics associated with quality.

Methods: Many survey questions were drawn from existing conceptual models and survey instruments. We used factor analysis to create new scales from questions that were not part of established scales. We used correlation coefficients and multivariable models to examine relationships among variables.

Results and Conclusions: Variables most strongly associated with perceived quality included standardized and simplified care processes resulting in coordinated care and smooth handoffs, a clear sense of organizational direction and clear action plans, and communication with staff about reasons for change and improvement progress made. Of those variables with a strong relationship to quality, ones with relatively low mean ratings included workgroup coordination; sufficient resources and support for improvement; training; and efficient use of people, time, and energy. These are important areas on which management should focus to improve employee ratings of quality.

Center for Organization, Leadership, and Management Research, VA Boston Healthcare System (Drs Shwartz, Cramer, Cohen, Restuccia, Lukas, Sullivan, Charns and Ms Holmes), School of Management, Boston University (Drs Shwartz and Restuccia), Boston University School of Public Health (Drs Cramer, Lukas, and Charns), and Boston University Health Policy Institute (Ms Holmes and Dr Cohen), Massachusetts.

Correspondence: Michael Shwartz, PhD, School of Management, Boston University, 595 Commonwealth Ave, Boston, MA 02215 (

This study was supported in part by a grant from the Robert Wood Johnson Foundation.

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

©2010Lippincott Williams & Wilkins, Inc.