A review of hospital characteristics associated with improved performance

Brand, Caroline A., Barker, Anna L., Morello, Renata T., Vitale, Michael R., Evans, Sue M., Scott, Ian A., Stoelwinder, Johannes U. and Cameron, Peter A. (2012) A review of hospital characteristics associated with improved performance. International Journal for Quality in Health Care, 24 5: 483-494. doi:10.1093/intqhc/mzs044

Author Brand, Caroline A.
Barker, Anna L.
Morello, Renata T.
Vitale, Michael R.
Evans, Sue M.
Scott, Ian A.
Stoelwinder, Johannes U.
Cameron, Peter A.
Title A review of hospital characteristics associated with improved performance
Journal name International Journal for Quality in Health Care   Check publisher's open access policy
ISSN 1353-4505
Publication date 2012-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/intqhc/mzs044
Volume 24
Issue 5
Start page 483
End page 494
Total pages 12
Place of publication Cary, NC, United States
Publisher Oxford University Press
Collection year 2013
Language eng
Formatted abstract
The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance.

Data sources:
The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles.

Study selection and data extraction:
Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles.

Data synthesis:

Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume.

There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.
Keyword Health services
Outcome assessment
Hospital performance
Adverse events
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 20 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 15 Nov 2012, 12:08:27 EST by System User on behalf of Medicine - Princess Alexandra Hospital