title: Development and validation of an index to assess hospital quality management systems.
abstract: OBJECTIVE
  The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries.
  
  
  METHODS
  Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument.
  
  
  METHODS
  As part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents.
  
  
  METHODS
  The extent of implementation of QMSs.
  
  
  RESULTS
  Factor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27.
  
  
  CONCLUSIONS
  Assessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands. c.wagner@nivel.nl.
authors.forename: C
authors.initials: C
authors.lastname: Wagner
authors.forename: O
authors.initials: O
authors.lastname: Groene
authors.forename: C A
authors.initials: CA
authors.lastname: Thompson
authors.forename: N S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: M
authors.initials: M
authors.lastname: Dersarkissian
authors.forename: O A
authors.initials: OA
authors.lastname: Arah
authors.forename: R
authors.initials: R
authors.lastname: Suñol
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005060:Europe; D005163:Factor Analysis, Statistical; D005260:Female; D006740:Hospital Administrators; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D061214:Patient Safety; D011594:Psychometrics; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: health care system; hospital care; patient safety; quality management; surveys