title: Longitudinal analysis on the development of hospital quality management systems in the Netherlands.
abstract: OBJECTIVE
  Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals.
  
  
  METHODS
  Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage.
  
  
  METHODS
  Dutch hospital sector between 1995 and 2007.
  
  
  METHODS
  Hospital organizations.
  
  
  METHODS
  Changes through time.
  
  
  METHODS
  Quality management system development stage.
  
  
  RESULTS
  Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size.
  
  
  CONCLUSIONS
  Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Otterstraat, Utrecht, The Netherlands. m.l.duckers@amc.uva.nl
authors.forename: Michel
authors.initials: M
authors.lastname: Dückers
authors.forename: Peter
authors.initials: P
authors.lastname: Makai
authors.forename: Leti
authors.initials: L
authors.lastname: Vos
authors.forename: Peter
authors.initials: P
authors.lastname: Groenewegen
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D017598:Efficiency, Organizational; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000379:methods; D006291:Health Policy; D006739:Hospital Administration / Q000191:economics / Q000379:methods* / Q000592:standards; D006761:Hospitals / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D009426:Netherlands; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D017751:Safety Management / Q000379:methods / Q000592:standards; D017749:Total Quality Management / Q000379:methods* / Q000592:standards