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Management practices and the quality of care in cardiac units


  • McConnell, K. John
  • Lindrooth, Richard C.
  • Wholey, Douglas R.
  • Maddox, Thomas M.
  • Bloom, Nicholas


Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; assess association of these practices with processes of care, readmissions, and mortality for patients with acute myocardial infarction (AMI); and suggest specific directions for the testing and dissemination of health care management approaches. Design:- We adapted an approach used to measure management and organizational practices in manufacturing to collect management data on cardiac units. We scored performance in 18 practices using the following 4 dimensions: standardizing care, tracking of key performance indicators, setting targets, and incentivizing employees. We used multivariate analyses to assess the relationship of management practices with process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for acute myocardial infarction (AMI). Setting:- Cardiac units in US hospitals. Participants_ Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges. Main Outcome Measures:- Process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for AMI. Results:- We found a wide distribution in management practices, with fewer than 20% of hospitals scoring a 4 or a 5 (best practice) on more than 9 measures. In multivariate analyses, management practices were significantly correlated with mortality (P = .01) and 6 of 6 process measures (P

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  • McConnell, K. John & Lindrooth, Richard C. & Wholey, Douglas R. & Maddox, Thomas M. & Bloom, Nicholas, 2013. "Management practices and the quality of care in cardiac units," LSE Research Online Documents on Economics 59336, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:59336

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    1. repec:mpr:mprres:6335 is not listed on IDEAS
    2. Harlan M. Krumholz & Angela R. Merrill & Eric M. Schone & Geoffrey C. Schreiner & Jersey Chen & Elizabeth H. Bradley & Yun Wang & Yongfei Wang & Zhenqiu Lin & Barry M. Straube & Michael T. Rapp & Shar, "undated". "Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission," Mathematica Policy Research Reports f7843a224adc47a1b345f9191, Mathematica Policy Research.
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    Cited by:

    1. Sacarny, Adam, 2018. "Adoption and learning across hospitals: The case of a revenue-generating practice," Journal of Health Economics, Elsevier, vol. 60(C), pages 142-164.
    2. Nicholas Bloom & Renata Lemos & Raffaella Sadun & John Van Reenen, 2020. "Healthy Business? Managerial Education and Management in Health Care," The Review of Economics and Statistics, MIT Press, vol. 102(3), pages 506-517, July.
    3. Aled ab Iorwerth, 2013. "Mastering Leviathan: A Review Article on "Growing the Productivity of Government Services"," International Productivity Monitor, Centre for the Study of Living Standards, vol. 26, pages 94-107, Fall.
    4. Amitabh Chandra & Amy Finkelstein & Adam Sacarny & Chad Syverson, 2016. "Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector," American Economic Review, American Economic Association, vol. 106(8), pages 2110-2144, August.
    5. Kalodimos, Jonathan, 2017. "Internal governance and performance: Evidence from when external discipline is weak," Journal of Corporate Finance, Elsevier, vol. 43(C), pages 193-216.
    6. Dorgan, Stephen J. & Powell-Jackson, Timothy & Briggs, Andrew, 2024. "Measuring healthcare payor management practices in England," Social Science & Medicine, Elsevier, vol. 340(C).
    7. Rachet-Jacquet, Laurie, 2022. "Do breaks from surgery improve the performance of orthopaedic surgeons?," Journal of Health Economics, Elsevier, vol. 85(C).
    8. Arimoto, Yutaka & 有本, 寛 & Kurata, Masamitsu, 2017. "Adoption of Management Practices in the Public Sector of Bangladesh," Discussion Paper Series 654, Institute of Economic Research, Hitotsubashi University.
    9. Etienne Minvielle & John R. Kimberly, 2020. "Paying for Quality: Rewarding organizational efforts along the continuum of care [Rémunération à la qualité : Récompenser les efforts organisationnels le long du parcours du patient]," Post-Print hal-03058626, HAL.
    10. Janet M. Currie & W. Bentley MacLeod, 2018. "Understanding Doctor Decision Making: The Case of Depression," NBER Working Papers 24955, National Bureau of Economic Research, Inc.
    11. Adam Pilny & Felix Roesel, 2020. "Are Doctors Better Health Ministers?," American Journal of Health Economics, University of Chicago Press, vol. 6(4), pages 498-532.
    12. Ambar La Forgia, 2023. "The Impact of Management on Clinical Performance: Evidence from Physician Practice Management Companies," Management Science, INFORMS, vol. 69(8), pages 4646-4667, August.
    13. Jannis Angelis & Anna Häger Glenngård & Henrik Jordahl, 2021. "Management practices and the quality of primary care," Public Money & Management, Taylor & Francis Journals, vol. 41(3), pages 264-271, April.
    14. Lee, Yong Suk, 2018. "Modern management and the demand for technical skill," Labour Economics, Elsevier, vol. 55(C), pages 328-343.
    15. Sandra G. Sosa-Rubí & Sergio Bautista-Arredondo & Carlos Chivardi-Moreno & David Contreras-Loya & Gina Hera-Fuentes & Marjorie Opuni, 2021. "Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia," Health Care Management Science, Springer, vol. 24(1), pages 41-54, March.
    16. Amitabh Chandra & Carrie H. Colla & Jonathan S. Skinner, 2023. "Productivity Variation and Input Misallocation: Evidence from Hospitals," NBER Working Papers 31569, National Bureau of Economic Research, Inc.
    17. Catherine Buffington & Lucia Foster & Ron Jarmin & Scott Ohlmacher, 2016. "The Management and Organizational Practices Survey (MOPS): An Overview," Working Papers 16-28, Center for Economic Studies, U.S. Census Bureau.
    18. Erlyn K Macarayan & Hannah L Ratcliffe & Easmon Otupiri & Lisa R Hirschhorn & Kate Miller & Stuart R Lipsitz & Atul A Gawande & Asaf Bitton, 2019. "Facility management associated with improved primary health care outcomes in Ghana," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-19, July.
    19. K. John McConnell & Richard C. Lindrooth & Douglas R. Wholey & Thomas M. Maddox & Nick Bloom, 2016. "Modern Management Practices and Hospital Admissions," Health Economics, John Wiley & Sons, Ltd., vol. 25(4), pages 470-485, April.
    20. Wang, Yongjin & Zhao, Laixun, 2015. "Saving good jobs from global competition by rewarding quality and efforts," Journal of International Economics, Elsevier, vol. 96(2), pages 426-434.
    21. Emek Basker & Randy A. Becker & Lucia Foster & T. Kirk White & Alice Zawacki, 2019. "Addressing Data Gaps: Four New Lines of Inquiry in the 2017 Economic Census," Working Papers 19-28, Center for Economic Studies, U.S. Census Bureau.
    22. Manhal Ali & Reza Salehnejad & Mohaimen Mansur, 2018. "Hospital heterogeneity: what drives the quality of health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(3), pages 385-408, April.

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      JEL classification:

      • J50 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - General

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