Relationship between organizational factors and performance among pay-for-performance hospitals.
BACKGROUND
The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.


METHODS
An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture.


RESULTS
More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05).


CONCLUSIONS
Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.
Vina
Ernest R
ER
Zynx Health, 10880 Wilshire Blvd., Los Angeles, CA 90024, USA.
Rhew
David C
DC
Weingarten
Scott R
SR
Weingarten
Jason B
JB
Chang
John T
JT
D015331:Cohort Studies; D003625:Data Collection; D004526:Efficiency; D017598:Efficiency, Organizational; D006801:Humans; D007857:Leadership; D017146:Models, Organizational; D015279:Organizational Culture; D010816:Physician Incentive Plans / Q000191:economics*; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D014481:United States