title: Measuring performance improvement: total organizational commitment or clinical specialization.
abstract: BACKGROUND
  Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures.
  
  
  METHODS
  We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital.
  
  
  RESULTS
  All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement.
  
  
  CONCLUSIONS
  Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.
authors.affiliation: Center for Quality Improvement Research, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA. aleece.caron@med.va.gov
authors.forename: Aleece
authors.initials: A
authors.lastname: Caron
authors.forename: Paul
authors.initials: P
authors.lastname: Jones
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D006801:Humans; D007857:Leadership; D007902:Length of Stay; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D017749:Total Quality Management; D014481:United States