Quality improvement strategies and tools: A comparative analysis between Italy and the United States

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign\r\ntheir quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both\r\ncountries, aims to identify commonalities and differences between the two systems and to understand which approaches are\r\neffective in improving quality of care. In both countries chief quality officers report quality improvement has become a\r\nstrategic priority, clinical governance approaches, and tools—such as disease-specific quality improvement projects and\r\nclinical pathways—are commonly used, and there is widespread awareness that clinical decision making must be supported\r\nby protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide\r\napproach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for\r\ndifferent dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not\r\ntypically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization\r\nbut are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the\r\ntypical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical\r\nspecialties than in the United States. In both countries, the results of the study show that it is not the single methodology/\r\nmodel that makes the difference but how the different quality improvement strategies and tools interact to each other and\r\nhow they are coherently embedded with the overall organizational strategy.