title: Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis.
abstract: OBJECTIVE
  To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals.
  
  
  METHODS
  A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits.
  
  
  METHODS
  One hundred and fifty-five CEOs and 155 quality managers.
  
  
  METHODS
  One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda.
  
  
  RESULTS
  Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships.
  
  
  CONCLUSIONS
  Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht, The Netherlands. d.botje@nivel.nl.
authors.forename: Daan
authors.initials: D
authors.lastname: Botje
authors.forename: N S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: R
authors.initials: R
authors.lastname: Suñol
authors.forename: O
authors.initials: O
authors.lastname: Groene
authors.forename: H
authors.initials: H
authors.lastname: Pfaff
authors.forename: R
authors.initials: R
authors.lastname: Mannion
authors.forename: A
authors.initials: A
authors.lastname: Depaigne-Loth
authors.forename: O A
authors.initials: OA
authors.lastname: Arah
authors.forename: M
authors.initials: M
authors.lastname: Dersarkissian
authors.forename: C
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000328:Adult; D016542:Chief Executive Officers, Hospital; D003430:Cross-Sectional Studies; D003659:Decision Making, Organizational; D005060:Europe; D005260:Female; D006075:Governing Board; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009937:Organizational Objectives; D016730:Program Development; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014421:Turkey
keywords: acute care hospitals; executive board; external pressure; international research; quality management; quality on the agenda