Leadership, Safety Climate and CQI:

Article No 5
Impact on Process Quality and Patient Safety
Title: Leadership, Safety Climate and CQI: Impact
on Process Quality and Patient Safety
Problem:
Healthcare industry is under increased pressure to reform due to increasing cost
and demands, both from customers and third party payer.
Patient safety is one of the pressing challenges faced by healthcare system.
Progress is minimal in excluding medical errors.

Variable: Patient Safety Climate (PSC), Transformational Leadership (TFL), safety

climate, Continuous Quality Improvements (CQI).
Controlled Variables: Hospital size (measured by the natural log of the number of
beds), teaching status (teaching vs. nonteaching hospital), system or non-
system membership, and presence of multiple respondents.
Indicator variables: Urban or rural location, private or government ownership,
and for-profit or not-for-profit status. (Collected from CMS)

Hypothesis:
(H1) TFL will be positively associated with patient safety climate.
(H2) Patient safety climate will be positively associated with CQI initiatives.
(H3) CQI initiatives will be negatively associated with HAC rates, a patient safety
outcome measure
(H4) CQI initiatives will be positively associated with PQSs, a process quality
measure.

Sample: The study was conducted as a survey in hospitals from 48 of 50 U.S.

states. The final sample size was 204 hospitals with a response rate of 33%.

Data collection Instrument:

The survey was conducted through a questionnaire.
Questionnaire was initially pilot tested by sending it to various directors of local
hospitals. Telephone interviews were also initially conducted to improve clarity
and reduce ambiguity.
The questionnaire includes items based on prior research relating to TFL, safety
climate, and CQI.
The published Multifactor Leadership Questionnaire 5-point scale was used to
measure TFL.
The PSC construct was measured on a 6-point scale using six items taken from a
published Safety Climate Survey.
CQI was measured using three items that are statistical quality/process control
using control charts, process competitive benchmarking of best in class
processes, and quality teams of employees.
Patient safety outcomes were measured using HAC data obtained from Hospital
Compare.
Process quality performance outcomes were measured using the PQS data also
obtained from Hospital Compare.

RESEARCH SURVEY METHODOLOGY ZARA KHAN 20026

Leadership, Safety Climate and CQI:
Article No 5
Impact on Process Quality and Patient Safety
Data Analysis: Structural equation modeling (SEM) was used as the primary
analytical technique. AMOS version 19.0 was used to estimate the measurement
and structural models.

Results:
The studies show support to H1, H2 and H4.
H3 was not supported because, although it was significant, the relationship
between CQI initiatives and HAC rates was positive, not negative as predicted.
PSC was negatively related to HAC rate.
Hospital size was positively related to CQI.
Urban location was positively related to PQS.
Teaching status was negatively related to PQS.
Private ownership was negatively related to HAC rate and positively related to
PQS.
All other relationships with control variables were non-significant.
Given that the multi respondent control variable, which indicates whether the
hospital had single or multiple respondents, was not significantly related to any
variable in the model.

Conclusion:
The study provides an understanding between the safety and the quality and
suggests that safety and quality are not identical and may possess some effects
against each other. The hospitals give priority to implementation of patient safety
and quality outcomes. CQI implementation in hospitals is focused more towards the
interest of improving business processes and quality results, rather than towards
the interest of patient safety. The findings indicate that combining PSC with CQI
initiatives could be effective in addressing safety outcomes.
A emphasize is also placed upon the importance of leadership. The employees
perception of a strong safety climate is greatly influenced by hospital CEOs TFL
style. TFL style is negatively related to both CQI implementation and PQSs. But,
hospitals with a strong PSC were more likely to successfully implement CQI and CQI
initiatives in turn are associated with higher PQSs.
It can be prcised that implementing quality initiatives can help achieves benefits in
quality outcomes. Moreover, hospital leaders can improve patient safety outcomes
by focusing on implementation of safety initiatives to see desirable results in safety.

RESEARCH SURVEY METHODOLOGY ZARA KHAN 20026