title: A systematic review of instruments that assess the implementation of hospital quality management systems.
abstract: OBJECTIVE
  Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management systems, (ii) describe their measurement properties and (iii) assess the effects of quality management on quality improvement and quality of care outcomes.
  
  
  METHODS
  We performed a systematic literature search from 1990 to 2011 in PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science. In addition, we used snowball strategies, screened the reference lists of eligible papers, reviewed grey literature and contacted experts in the field.
  
  
  METHODS
  and data extraction Two reviewers screened eligible papers based on pre-defined inclusion and exclusion criteria and all authors extracted data. Eligible papers are described in terms of general characteristics (settings, type and level of respondents, mode of data collection), methodological properties (sampling strategy, item derivation, conceptualization of quality management, assessment of reliability and validity, scoring) and application/implementation (accounting for context, organizational adaptations, sensitivity to change, deployment and effect size).
  
  
  RESULTS
  Eighteen papers were deemed eligible for inclusion. While some common domains emerged in measurement conceptualization, substantial differences in scope persist. The instruments' measurement properties were insufficiently described and only few instruments assessed links between the implementation of quality management systems (QMS) and improvement strategies or outcomes.
  
  
  CONCLUSIONS
  There is currently no well-established measure to assess the implementation and effectiveness of quality management systems. Future research should address this gap.
authors: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. oliver.groene@lshtm.ac.uk.
authors: Oliver
authors: O
authors: Groene
authors: Daan
authors: D
authors: Botje
authors: Rosa
authors: R
authors: Suñol
authors: Maria Andrée
authors: MA
authors: Lopez
authors: Cordula
authors: C
authors: Wagner
mesh_terms: D006739:Hospital Administration / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016730:Program Development / Q000379:methods / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data
keywords: hospital care; quality management; quality measurement; setting of care