An exploration of management practices in hospitals

Background: Management practices, including, for example, "Lean" methodologies originally developed at Toyota, may represent one mechanism for improving healthcare performance. Methods: We surveyed 597 nurse managers at cardiac units to score management on the basis of poor, average, or high performance on 18 practices across 4 dimensions (Lean operations, performance measurement, targets, and employee incentives). We assessed the relationship of management scores to hospital characteristics (size, non-profit status) and market level variables. Results: Our findings provide concrete examples of the high degree of management proficiency of some hospitals, as well as wide variation in management practices. Although the exact ways in which these tools have been implemented vary across hospitals, we identified multiple examples of units that use standardization in their care, track performance on a frequent basis and display data in a visual manner, and set aggressive goals and communicate them clearly to their staff. Regression models indicate that higher management scores are associated with hospitals in more competitive markets, teaching hospitals, and hospitals with a higher net income from patient services (p<0.05). Conclusions: High quality management practices have been successfully adopted by some hospitals in the US, but the ways in which these practices have been implemented may vary, reflecting the specific context or environment of the hospital. The adoption of modern management practices may be driven in part by market pressure. Implications: An improved understanding of key management practices may assist researchers and policy-makers in identifying mutable hospital characteristics that can drive efficiency, safety, and quality.