Management Practices in U.S. Hospitals

项目摘要 为什么有些医院的医疗质量比其他医院好？有充分的证据表明，美国的医疗保健 该系统的特点是效率低，协调差，和高度可变的护理质量的问题。的 研究文献集中在一些可能影响质量的因素上，但相对而言知之甚少 医院内部管理的方式 此应用程序寻求资金进行调查，将产生一个全新的数据集， 美国医院的大样本管理实践。我们所说的管理实践是指政策， 用于指导医院运营、绩效衡量、临床 关系和员工激励。衡量这些实践并不容易， 传统调查或依赖行政数据。我们将采用创新的调查方法， 这是一个重大突破，它能够获得有关组织做法的真实信息， 最小化对有利分数的反应的博弈。 该应用程序的总体目标是衡量美国医院及其协会的管理实践 患者的结果。拟议研究背后的具体假设是， 与更好的患者结局相关的管理技术，但未被广泛采用，或 在医院内部传播。这项调查及其与医院、病人和医疗机构现有数据的联系 成果和质量指标，将解决有关政策和 这是医院如何运作的关键。拟议的研究将是第一个打开“黑匣子”的， 美国医院管理，并评估其对患者预后的重要性。 这项建议有三个具体目标： 具体目标1。调查和衡量美国800家医院的管理实践。 具体目标2。解释为什么不同医院的管理方法不同。 具体目标3。评估管理实践得分与患者护理质量之间的关系。 这项研究旨在提高对这些工具的理解-它们的使用频率以及它们的 明显的有效性-以便医院可以推广和更快地采用好的工具， 最终目标是改善患者的治疗效果。

Project Summary 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: Specific Aim 1. Survey and measure management practices in 800 U.S. hospitals. Specific Aim 2. Explain why management practices vary across hospitals. Specific 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.