title: DUQuE quality management measures: associations between quality management at hospital and pathway levels.
abstract: OBJECTIVE
  The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures.
  
  
  METHODS
  It is a multi-level, cross-sectional, mixed-method study.
  
  
  METHODS
  As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used.
  
  
  METHODS
  Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR).
  
  
  RESULTS
  Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments.
  
  
  CONCLUSIONS
  By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.
authors.affiliation: PO Box 1568, Utrecht 3500 BN, The Netherlands. c.wagner@nivel.nl.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.forename: Oliver
authors.initials: O
authors.lastname: Groene
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Maral
authors.initials: M
authors.lastname: Dersarkissian
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.forename: Rosa
authors.initials: R
authors.lastname: Suñol
mesh_terms: D019091:Critical Pathways / Q000592:standards*; D003430:Cross-Sectional Studies; D005060:Europe; D006740:Hospital Administrators; D006761:Hospitals / Q000592:standards*; D061214:Patient Safety; D011785:Quality Assurance, Health Care / Q000592:standards*; D011786:Quality Control; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: external quality assessment; hospital care; measurement of quality; organization science, healthcare system; patient safety; quality improvement; quality management