TY - JOUR
T1 - Quality improvement strategies and tools: A comparative analysis between Italy and the United States
AU - Villa, Stefano
AU - Restuccia, Joseph D
AU - Restuccia, Joseph
AU - Anessi Pessina, Eugenio
AU - Rizzo, Marco Giovanni
AU - Cohen, Alan B
PY - 2018
Y1 - 2018
N2 - Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign
their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both
countries, aims to identify commonalities and differences between the two systems and to understand which approaches are
effective in improving quality of care. In both countries chief quality officers report quality improvement has become a
strategic priority, clinical governance approaches, and tools—such as disease-specific quality improvement projects and
clinical pathways—are commonly used, and there is widespread awareness that clinical decision making must be supported
by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide
approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for
different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not
typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization
but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the
typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical
specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/
model that makes the difference but how the different quality improvement strategies and tools interact to each other and
how they are coherently embedded with the overall organizational strategy.
AB - Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign
their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both
countries, aims to identify commonalities and differences between the two systems and to understand which approaches are
effective in improving quality of care. In both countries chief quality officers report quality improvement has become a
strategic priority, clinical governance approaches, and tools—such as disease-specific quality improvement projects and
clinical pathways—are commonly used, and there is widespread awareness that clinical decision making must be supported
by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide
approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for
different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not
typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization
but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the
typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical
specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/
model that makes the difference but how the different quality improvement strategies and tools interact to each other and
how they are coherently embedded with the overall organizational strategy.
KW - Italy, quality, United States of America
KW - Italy, quality, United States of America
UR - http://hdl.handle.net/10807/115375
U2 - 10.1177/0951484818755534
DO - 10.1177/0951484818755534
M3 - Article
SN - 0951-4848
VL - 31
SP - 205
EP - 217
JO - Health Services Management Research
JF - Health Services Management Research
ER -