title: The role of hospital managers in quality and patient safety: a systematic review.
abstract: OBJECTIVE
  To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care.
  
  
  METHODS
  A systematic review of the literature.
  
  
  METHODS
  A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15,447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles.
  
  
  RESULTS
  The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals.
  
  
  CONCLUSIONS
  There is some evidence that managers' time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance.
authors.affiliation: Department of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: Anam
authors.initials: A
authors.lastname: Parand
authors.affiliation: Said Business School, University of Oxford, Oxford, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Dopson
authors.affiliation: Department of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Renz
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: D006740:Hospital Administrators; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D061214:Patient Safety / Q000592:standards*; D024382:Professional Role; D011787:Quality of Health Care / Q000592:standards*
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Leadership; Patient Safety; Systematic literature review