Management Practices in U.S. Hospitals

描述（由申请人提供）：为什么一些医院的护理质量比其他医院好？有充分的证据表明，美国医疗保健系统的特点是效率低下、协调不力和医疗质量高度多变。研究文献集中在一些可能影响质量的因素上，但对医院内部管理方式的了解相对较少。本申请寻求资金来进行一项调查，该调查将在美国医院的大量样本中产生一套全新的管理实践数据。通过管理实践，我们指的是用于指导医院运营、绩效评估、临床关系和员工激励的政策、系统和标准。通过传统的调查或依赖行政数据来衡量这些做法并不容易。我们将使用一种创新的调查方法，该方法在获取组织实践的真实信息和最大限度地减少对有利分数的反应的博弈能力方面取得了重大突破。本应用程序的总体目标是衡量美国医院的管理实践及其与患者预后的关系。提出的研究背后的具体假设是，有一些管理技术与更好的患者预后相关，但在医院部门内没有广泛采用或传播。这项调查以及它与医院、患者结果和质量指标的现有数据的联系，将解决关于确定医院如何运作的政策和做法的知识方面的一个重要空白。这项拟议的研究将是第一个打开这个领域的研究。美国医院管理的黑箱，并评估其对患者预后的重要性。这项建议有三个具体目标：目标1。调查和衡量美国800家医院的管理实践。目标2。解释为什么不同医院的管理实践不同。目标3。评估管理实践评分与患者护理质量之间的关系。本研究旨在提高对这些工具的理解、使用频率以及其明显的有效性，从而使好的工具能够被医院推广并更快地采用，最终目的是改善患者的治疗效果。

DESCRIPTION (provided by the applicant): Why is the quality of care in some hospitals better than others? It is well documented that the U.S. health care system is marked by problems of inefficiency, poor coordination, and highly variable quality of care. The research literature has focused on a number of factors that could affect quality, but relatively little is known about the ways in which hospitals are internally managed. This application seeks funding to conduct a survey that will produce an entirely new set of data on management practices in a large sample of U.S. hospitals. By management practices, we mean the policies, systems, and standards that are used to guide hospital operations, performance measurement, clinical relationships, and employee incentives. Measuring these practices is not easily accomplished through traditional surveys or reliance on administrative data. We will use an innovative survey methodology that represents a significant breakthrough in its ability to elicit true information on organizational practices and to minimize the gaming of responses toward favorable scores. The overall goal of this application is to measure management practices in U.S. hospitals and their association with patient outcomes. The specific hypothesis behind the proposed research is that there are managerial techniques that are associated with better patient outcomes, but not widely adopted or disseminated within the hospital sector. The survey, and its linkage with existing data on hospitals, patient outcomes, and quality indicators, will address an important gap in the knowledge about the policies and practices that define how a hospital operates. The proposed study would be the first to open the .black box of U.S. hospital management, and to assess its importance in patient outcomes. This proposal has three specific aims: Aim 1. Survey and measure management practices in 800 U.S. hospitals. Aim 2. Explain why management practices vary across hospitals. Aim 3. Assess the relationship between management practice scores and the quality of patient care. This research aims to improve the understanding of these tools, their frequency of use as well as their apparent effectiveness, so that good tools can be promoted and more quickly adopted by hospitals, with the ultimate goal of improving patient outcomes.