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Health Care Quality

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Total quality management appears to have little impact on outcomes of coronary bypass surgery patients

Total quality management (TQM) is a process increasingly used by hospitals to improve the quality and outcomes of care. It is the systematic involvement of health care teams in identifying the underlying causes of unnecessary variation in processes and outcomes of care and taking corrective and preventive action with the goal of continually improving patient care delivery.

Although specific TQM interventions to improve care have met with some success, most of these have been limited to a single site and a narrow set of outcomes. A recent study of 16 hospitals that perform at least 200 coronary artery bypass graft (CABG) surgeries a year found that little of the two- to four-fold difference among hospitals in CABG outcomes was associated with TQM or a supportive organizational culture emphasizing collaboration and teamwork.

The study was supported in part by the Agency for Healthcare Research and Quality (HS08523) and led by Stephen M. Shortell, Ph.D., of the University of California, Berkeley. The researchers surveyed an average of 54 clinicians and administrative support staff at each site who were directly involved in the care of CABG patients to assess the hospital's TQM implementation and culture. Patients undergoing CABG from hospitals with high TQM scores were more satisfied with their nursing care but were more apt to have hospital stays greater than 10 days. A supportive group culture was associated with shorter postoperative intubation time and higher patient physical and mental functioning scores 6 months after CABG; however, operating room times were longer. There was no association between risk-adjusted mortality and either TQM scores or culture.

The researchers note that the provision of medical care is a complex, highly interdependent process influenced by multiple variables. They highlight the need to further examine the relationships between and among individual professional skills and motivation, group and microsystem team processes, and specifically tailored interventions, along with larger, organization-wide issues involving culture, leadership, decision support systems, and incentives.

See "Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coronary artery bypass graft surgery patients," by Dr. Shortell, Robert H. Jones, M.D., Alfred W. Rademaker, Ph.D., and others, in the February 2000 Medical Care 38(2), pp. 207-217.

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