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The importance of ensuring health care quality has been recognized by all developed nations. Some examples are The European Observatory on Health Systems and Policies (EOHSP) in the European Union and The Joint Commission in the United States. In most cases these efforts compare health care provider organization within the specific country or other political unit (Wagner et al., 2014). This study deals with some potentially important factors affecting health care quality in the USA. From a hospital patient perspective, the importance of health care quality is universally recognized, particularly by those who are presently requiring or have required medical care at one time or another.
From the organization perspective, hospital quality seems less well recognized. Many authors have addressed the potential factors leading to hospital quality (Missios & Bekelis, 2018; Montgomery et al., 2013; Stimpfel et al., 2016). However, based on their meetings agendas, hospital Governing Board, and top managers have shown a relatively weak interest in hospital quality issues. Some hospitals’ agenda did not include quality on their agenda (Jha & Epstein 2010; Joshi & Hines, 2006), or quality issues were inconsistently or sporadically addressed (Mastal et al., 2007; Prybil et al., 2010). More in depth studies regarding the Board’s time spent on patient safety or care quality, found that such issues took less than expected (Baker et al., 2010 ; Jha & Epstein 2010; Jiang et al., 2008 ; Jiang et al., 2009 ; Levey et al., 2007; Prybil et al., 2010). Most Boards reported that hospital quality issues accounted for 25% or less of their time (Baker et al., 2010; Jha & Epstein, 2010; Jiang et al., 2009; Poniatowski et al., 2005 ; Prybil et al., 2010; Vaughn et al., 2006).
Many studies have addressed the lower level management involvement and its effect on hospital quality. These studies propose that lower-level managerial action has been beneficial to hospital quality and performance (Baker et al., 2010; Bradley et al., 2006; Jiang et al., 2009; Joshi & Hines, 2006; Vaughn et al., 2006; Weingart & Page, 2004). On the other hand, the literature also has many conflicting studies concerning senior management support and engagement in hospital quality improvement initiatives. In some studies, support and engagement at the top levels of management was found to be one of the primary factors associated with good hospital quality outcomes, including success implementing quality improvement programs (Bradley et al., 2006; Jiang et al., 2009; Joshi & Hines, 2006; Vaughn et al., 2006). However, several studies indicate that management involvement (at several levels) has little, no or even a negative influence on hospital quality (Caine & Kenrick, 1997; Jiang et al., 2009; Joshi & Hines, 2006; Saint et al., 2010; Vaughn et al., 2006).