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Quality improvement capacity: a survey of hospital quality managers
  1. A R Gagliardi1,
  2. C Majewski2,
  3. J C Victor3,
  4. G R Baker3
  1. 1Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Quality Healthcare Network, Toronto, Ontario, Canada
  3. 3University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Anna Gagliardi, Toronto General Research Institute, University Health Network, 200 Elizabeth Street, 13EN-235, Toronto, Ontario, Canada, M5G2C4; anna.gagliardi{at}


Background Skilled managers are an important component of quality improvement (QI) infrastructure, but there has been little evaluation of QI infrastructure, which is needed to guide enhancement of this capacity.

Methods Quality managers at 97 acute care hospitals in Ontario, Canada, were surveyed by mail to describe how their roles were integrated with QI performance objectives. Binary and scaled responses were analysed quantitatively, and open-ended responses were analysed thematically.

Results The response rate was 79.4%. Many QI managers were new to their role and had no support staff despite responsibility for multiple portfolios. Respondents thought that QI objectives should be less reactive to hospital executives or boards, adverse events or demands from government and accreditation bodies, and recommended that dedicated QI managers proactively apply explicit strategic plans and engage executives and clinicians. Findings were consistent regardless of rank, staffing or hospital type. Those with master's training and greater experience were more involved in strategic planning, data analysis and communication.

Conclusions QI is not well resourced in most acute care hospitals in Ontario. To develop QI capacity, investment and QI training may be required. Research should empirically establish objective performance measures of QI capacity to guide investment and evaluation.

  • Healthcare quality improvement
  • organisation
  • continuous quality improvement
  • quality assurance
  • healthcare
  • health facility administrators

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  • Funding This study was enabled with funding from the University of Toronto, Faculty of Medicine Dean's Fund New Staff Grant. The sponsor had no role in the design or conduct of the study.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Sunnybrook Health Sciences Centre, Toronto, Ontario.

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