title: The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.
abstract: OBJECTIVE
  To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009.
  
  
  METHODS
  A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators.
  
  
  METHODS
  In total, 169 residential care homes for the elderly in the Netherlands.
  
  
  METHODS
  Change between 2007 and 2009 in client-reported and professional indicators.
  
  
  RESULTS
  A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators.
  
  
  CONCLUSIONS
  This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Winters
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands.
authors.forename: R B
authors.initials: RB
authors.lastname: Kool
authors.affiliation: Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: N S
authors.initials: NS
authors.lastname: Klazinga
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Huijsman
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006801:Humans; D007857:Leadership; D009936:Organizational Innovation; D010358:Patient Participation; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012112:Residential Facilities / Q000458:organization & administration* / Q000592:standards
keywords: quality improvement; quality measurement; rehabilitation/long-term care; setting of care