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  1. Holger Pfaff1,
  2. Rosa Sunol2,
  3. Antje Hammer1,
  4. on behalf of the DUQuE Consortium
  1. 1Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine; University of Cologne; Cologne; Germany
  2. 2Avedis Donabedian Research Institute Universitat Autònoma de Barcelona; Barcelona; Spain


Introduction Previous empirical studies found that strategic leadership is an important organizational capability, and is essential for quality and safety improvement in hospital settings. Moreover, the quality of leadership depends crucially on a common set of shared values and relationships of mutual trust among hospital management board members. In accordance with the concept of social capital these are essential requirements for successful cooperation and coordination within groups. We therefore hypothesize that the degree of social capital within the hospital management boards is associated with the effectiveness and maturity of quality management system in European hospitals.

Methods For analysing the presumed relationship, we used data from the EU funded project “Deepening our understanding of quality improvement in Europe (DUQuE)”. Within the study we used a mixed-method approach to data collection and measurement in 188 hospitals of the 7 European countries Czech Republic, Germany, France, Poland, Portugal, Spain, and Turkey. The exposure social capital was measured with a six-item scale incorporated into the chief executive officer's (CEO) questionnaires. CEOs have been asked about their perceptions of social capital within the hospital management board. The outcome quality management system at the hospital level (QMSH) is a newly developed index, which consist of 46 items and 9 scales measuring a range of criteria related to quality improvement. The items were incorporated into the questionnaire for the quality manager (QM). In order to test the hypothesis, we conducted a multilevel linear regression model. We controlled for hospital ownership, number of beds, organizational culture, and the number of hospital board members. The country where the hospital is based was considered as confounder at the country level.

Results The average social capital score within the hospitals was 3.3 (standard deviation: 0.5; range: 1–4). The average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0–27). Higher social capital was associated with higher quality management system index scores (regression coefficient: 1.42; standard error: 0.64, p=0.029).

Discussion The results indicated a strong correlation between the exposure and the outcome variable. Social capital in hospital (management) boards positively influences quality management systems in European hospitals. For practical implication, the results indicate a potential advantage of strengthening the existing social capital in hospital management boards, perhaps by building trust through personal development courses or further education on teamwork within the hospital management board. Within the presentation results will be discussed in light of strengths (e.G. multi method approach) and limitations (e.G. cross-sectional design) of the study.

Declaration of competing interests This project has been funded by the European Commission's Seventh Framework Programme FP7/2007–2013 under grant agreement number 24188.

  • Patient safety
  • Mortality (standardized mortality ratios)
  • Patient education

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