While managers are looking for ways to improve healthcare performance, one popular hypothesis is that facilities that treat more patients are more efficient and have better clinical outcomes. Yet studies on the relationship between volume and outcomes have produced mixed results, indicating that other factors intervene. These factors have not been well documented through quantitative analysis of administrative databases. Using a qualitative approach, the objective of this study was to identify the organizational and professional variables that come into play in the relationship between hospital patient volume and surgical outcomes. Severity-adjusted rates of post-surgical complications following three common procedures were calculated for all hospitals in the province of Quebec, Canada. Hospitals were divided into quartiles according to their volume of patients and complication rate. For each of the three surgical procedures one hospital was randomly selected from each of the four extreme combinations (highest volume-highest complication rate, lowest volume-lowest complication rate, etc.). In each of the 12 selected hospitals, semi-structured interviews were conducted with 5-7 key informants (managers, physicians, nurses) to document the organizational and professional factors (structure and process variables) that could explain their high or low complication rate, given their high or low volume of patients. Results from the 69 interviews are complex and vary by procedure. Unique factors (e.g. agreement between hospital and community facilities for postoperative care, continuing education for operating room nurses) were identified. These will be presented and their implications discussed. This study provides a better understanding of the not-so-simple relationship between volume and outcomes.
Learning Objectives: 1. Explain the absence of systematic relationship between hospital volume and patient outcomes. 2. Identify hospital structure variables related to patient surgical outcomes. 3. Describe care process variables associated with patient surgical outcomes.
Keywords: Hospitals, Outcomes Research
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.