Review: how do hospital organizational structure and processes affect quality of care?: a critical review of research methods

Med Care Res Rev. 2008 Jun;65(3):259-99. doi: 10.1177/1077558707309613. Epub 2007 Dec 18.


Interest in organizational contributions to the delivery of care has risen significantly in recent years. A challenge facing researchers, practitioners, and policy makers is identifying ways to improve care by improving the organizations that provide this care, given the complexity of health care organizations and the role organizations play in influencing systems of care. This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure-process-outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure-quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Health Services Research / methods*
  • Hospital Administration*
  • Humans
  • Outcome and Process Assessment, Health Care / organization & administration*
  • Quality of Health Care*