The need for clear quality leadership by hospital CEOs

The extent to which medical specialists, nurses and other health care professionals adopt national quality norms, depends on the balance between quality measures at different levels and the leadership of hospital CEOs. This conclusion follows from the PhD study defended by Michel Dückers on the 9th of September at Utrecht University.

Between 2004 and 2009 a national change programme was implemented in Dutch hospitals, aimed at organisational development and quality improvement. In this layered programme interventions were implemented at sector, hospital and unit level. Michel Dückers studied how the programme was implemented and he also described some of its effects. Dückers clarifies how the programme helped to align the daily routines of professionals to national quality norms: ‘It is surprising how the combination of national norms, several improvement measures and external pressure actually seems to contribute to a more systematic quality management within hospitals. Congruence between measures at different levels is very important. The nature of quality management depends strongly on the leadership of hospital CEOs.’

Leadership
This leadership manifests itself in the extent to which CEOs formulate quality norms, make internal service level agreements with hospital units about these norms, and perform a periodical check whether norms are met. ‘Frequent accountability moments stimulate units to adopt health care innovations and to keep applying these.’ Dückers emphasises that it is ‘important that hospital staff notice that CEOs stimulate quality improvement. The project participation by physicians is higher when they and their colleagues experience that CEOs encourage improvement. The study, moreover, shows that some hospitals are better in supporting projects than others.’

Larger pattern
The programme fits within and build upon a larger complex of national policy measures. Quality norms and good examples have been defined. Gradually, the pressure on hospital performance increases. ‘This approach seems to work’ according to Dückers. ‘Since 1995 the quality management systems of hospitals have evolved. The next thing to do is to determine whether this was accompanied by an increase in the quality and safety of patient care in hospitals.’