Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership

Health Serv Res. 1997 Oct;32(4):491-510.


Study question: An examination of the effects of top management, board, and physician leadership for quality on the extent of clinical involvement in hospital CQI/TQM efforts.

Data sources: A sample of 2,193 acute care community hospitals, created by merging data from a 1989 national survey on hospital governance and a 1993 national survey on hospital quality improvement efforts.

Study design: Hypotheses were tested using Heckman's two-stage modeling approach. Four dimensions of clinical involvement in CQI/TQM were examined: physician participation in formal QI training, physician participation in QI teams, clinical departments with formally organized QA/QI project teams, and clinical conditions and procedures for which quality of care data are used by formally organized QA/QI project teams. Leadership measures included CEO involvement in CQI/TQM, board quality monitoring, board activity in quality improvement, active-staff physician involvement in governance, and physician-at-large involvement in governance. Relevant control variables were included in the analysis.

Principal findings: Measures of top management leadership for quality and board leadership for quality showed significant, positive relationships with measures of clinical involvement in CQI/TQM. Active-staff physician involvement in governance showed positive, significant relationships with clinical involvement measures, while physician-at-large involvement in governance showed significant, negative relationships.

Conclusions: Study results suggest that leadership from the top promotes clinical involvement in CQI/TQM. Further, results indicate that leadership for quality in healthcare settings may issue from several sources, including managers, boards, and physician leaders.

MeSH terms

  • Chief Executive Officers, Hospital*
  • Governing Board*
  • Health Care Surveys
  • Hospitals, Community / organization & administration
  • Hospitals, Community / standards*
  • Hospitals, Community / statistics & numerical data
  • Humans
  • Leadership*
  • Logistic Models
  • Medical Staff, Hospital*
  • Total Quality Management / organization & administration*
  • Total Quality Management / standards
  • Total Quality Management / statistics & numerical data
  • United States