Examining quality improvement programs: the case of Minnesota hospitals.

OBJECTIVE To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. DATA SOURCES Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. STUDY DESIGN As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. DATA COLLECTION/DATA EXTRACTION: Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings. The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. CONCLUSIONS There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.