title: Association between hospital size and quality improvement for pharmaceutical services.
abstract: OBJECTIVE
  The relationship between hospital size and quality improvement (QI) for pharmaceutical services was studied.
  
  
  METHODS
  A questionnaire on QI was sent to hospital pharmacy directors in Michigan and Florida in 2002. The questionnaire included items on QI lead-team composition, QI tools, QI training, and QI culture.
  
  
  RESULTS
  Usable responses were received from 162 (57%) of 282 pharmacy directors. Pharmacy QI lead teams were present in 57% of institutions, with larger teams in large hospitals (> or = 300 patients). Only two QI tools were used by a majority of hospitals: root-cause analysis (62%) and flow charts (66%). Small hospitals (< 50 patients) were less likely than medium-sized hospitals (50-299 patients) and large hospitals to use several QI tools, including control charts, cause-and-effect diagrams, root-cause analysis, flow charts, and histograms. Large hospitals were more likely than small and medium-sized hospitals to use root-cause analysis and control charts. There was no relationship between hospital size and the frequency with which physician or patient satisfaction with pharmaceutical services was measured. There were no differences in QI training or QI culture across hospital size categories.
  
  
  CONCLUSIONS
  A survey suggested that a majority of hospital pharmacies in Michigan and Florida have begun to adopt QI techniques but that most are not using rigorous QI tools. Pharmacies in large hospitals had more QI lead-team members and were more likely to use certain QI tools, but there was no relationship between hospital size and satisfaction measurements, QI training, or QI culture.
authors.affiliation: Center for Medication Use, Policy, and Economics, Department of Social and Administrative Sciences, College of Pharmacy, University of Michigan (UM), 428 Church Street, Ann Arbor, MI 48109-1065, USA. dnau@umich.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Nau
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Garber
authors.forename: Earlene E
authors.initials: EE
authors.lastname: Lipowski
authors.forename: James G
authors.initials: JG
authors.lastname: Stevenson
mesh_terms: D005069:Evaluation Studies as Topic; D006276:Health Facility Size; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D017060:Patient Satisfaction; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D011795:Surveys and Questionnaires; D014481:United States