The Study

In 2004, a group from the University of Iowa embarked on a study that focused on the impact that leadership has on quality outcomes in hospitals. The study began with on-site interviews with 96 hospital leaders in 18 community hospitals including Chief Executive Officers, Chief Medical Officers, and governing board members. The authors found what they interpreted to be considerable gaps between rhetoric about and existence of structures and processes for quality improvement activities. This initial study led to additional research and the creation of the Hospital Leadership and Quality Assessment Tool, HLQAT.

The Commonwealth Fund awarded a grant to the University of Iowa and an expanded research team in 2008 titled, “Improving Hospital Quality Through Leadership Assessment and Intervention” in order to identify structures, processes and leadership behaviors associated with high clinical quality. The goal of the project was to provide hospitals with a tool to guide their approaches to performance improvement.

The project team developed the HLQAT and administered the survey to over 600 hospitals and had more than 9,000 respondents complete the survey. The project team linked the HLQAT scores to several widely accepted hospital performance metrics to examine the relationship between hospital HLQAT scores and hospital quality outcomes as measured by a composite of the CMS Core Measures.

The findings of the study determined:

  • Regardless of which respondent group was considered (Board, C-Suite, or Clinical Managers) hospitals whose respondents had on average more positive perceptions on the HLQAT domains also had higher quality scores
  • Differences in the average domain responses between Board, C-Suites and Clinical Managers were smaller for high performing hospitals than for low performing hospitals

Quality and safety improvement begins with a comprehensive organizational self-assessment. The findings of this study indicate that the application of HLQAT can assist hospitals in identifying areas that require change and innovation.


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