Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coronary artery bypass graft surgery patients

OBJECTIVES. TO assess the impact of total quality management (TQM) and orga nizational culture on a comprehensive set of endpoints of care for coronary artery bypass graft surgery (CABG) patients, including risk-adjusted adver se outcomes, clinical efficiency, patient satisfaction, functional health s tatus, and cost of care. METHODS. Prospective cohort study of 3,045 eligible CABG patients from 16 h ospitals using risk-adjusted clinical outcomes, functional health status, p atient satisfaction, and cost measures. Implementation of TQM was measured by a previously validated instrument based on the Baldridge national qualit y award criteria. Organizational culture was measured by a previously valid ated 20-item instrument. Generalized estimating equations were used to cont rol for potential selection bias, repeated measures, and intraclass correla tion. RESULTS. A 2- to 4-fold difference in all major clinical CABG care endpoint s was observed among the 16 hospitals, but little of this variation was ass ociated with TQM or organizational culture. Patients receiving CABG from ho spitals with high TQM scores were more satisfied with their nursing care (P = 0.005) but were more likely to have lengths of stay >10 days (P = 0.0003 ). A supportive group culture was associated with shorter postoperative int ubation times (P = 0.01) but longer operating room times (P = 0.004). PI su pportive group culture was also associated with higher patient physical (P = 0.005) and mental (P = 0.01) functional health status scores 6 months aft er CABG. CONCLUSIONS. There was little effect of TQM and organizational culture on m ultiple endpoints of care for CABG patients. There is a need to examine fur ther the relationships among individual professional skills and motivations , group and microsystem team processes, specifically tailored interventions , and organization-wide culture, decision support processes, and incentives , Assessing the impact of such multifaceted approaches is an important area for further research.