Exploring the relationship between the breadth and depth of quality improvement activities and hospital performance in Taiwan

Background The relationship between the breadth and depth of quality improvement (QI) activities and hospital performance remains unclear. This study investigated the relationship between performance, external environment, and the breadth and depth of QI activities in hospitals. Methods The study used a longitudinal research design. Data regarding the breadth and depth of QI activities were collected using a questionnaire survey. The hospital performances were abstracted from the 2000-2009 national hospitals profiles. We adopted the year 2000 as the baseline and divided the study period into three, three-year periods. The Generalized Estimating Equations (GEE) model was used for the statistical analysis. Results The results showed a significant increase in the number of healthcare QI activities between 2000 and 2009. The results also showed that the breadth and depth of a hospital's QI activities were affected by the breadth and depth of its competitors' QI activities in the previous period and its own prior performance. In addition, the depth of QI activities in the previous period had a significant positive relationship with the number of inpatients and the turnover of beds. The breadth of QI activities in the previous period did not have a significant relationship with the selected hospital performance measures. Conclusion The study demonstrates that the breadth and depth of QI activities are affected by the external environment and by the hospital's own performance in the previous period. Furthermore, some performance measures are affected by the depth of the QI activities in the previous period.