Organizational Determinants of Quality Surgical Care
Sharp, Kimberly
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https://hdl.handle.net/2142/71018
Description
Title
Organizational Determinants of Quality Surgical Care
Author(s)
Sharp, Kimberly
Issue Date
1987
Department of Study
Sociology
Discipline
Sociology
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
Sociology, General
Health Sciences, Health Care Management
Abstract
Factors which affected the delivery of high quality surgical care to individual patients who received biliary surgery in a stratified random sample of 17 U.S. hospitals were investigated in this study. A causal model was developed to examine the organizational attributes which affected the quality of care delivered by individual surgeons and surgical staffs which incorporated hypotheses from the professional model and experience curve model. Two mechanisms of professional self-regulation proposed by the professional model were expected to affect surgeons' performance: (1) selection of staff members based on their professional qualifications and (2) peer review of ongoing performance. The experience curve model proposes that higher levels of clinical experience (assessed as current volume of cases treated and years of practice experience) of individual surgeons and surgical staffs would promote better performance.
The validity of these competing models as applied to individual surgeons and surgical staff organizations was examined by measuring performance based on Donabedian's conceptual scheme linking organizational structure, process and outcomes. In applying Donabedian's model, "good" quality of surgeons' performance was judged by the empirical link to better quality of their patients' outcomes. Thus, support of the hypotheses predicting better professional performance required a link between process (the surgeon's decisions and intraoperative behavior) and outcomes (less morbidity and mortality, adjusted for patient health related characteristics).
The results show that both professional self-regulation and level of experience had independent effects on professional performance. Greater peer control over members ongoing performance predicted better performance of individual surgeons, whereas greater control over selection predicted poorer performance. Greater current volume at the individual level and greater past experience at the staff level predicted better performance of individual surgeons.
The results document that the organizational setting of professional work (through greater peer review and more staff experience) as well as the experience of individual surgeons are causally linked to better quality of individual surgeon's performance as judged by the relationship of performance to outcome. Thus, this study provides evidence for the usefulness of applying the model linking structure to process to outcome to conceptualize the quality of surgical care.
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