Article Text

The role of hospital managers in quality and patient safety: a systematic review
  1. Anam Parand1,
  2. Sue Dopson2,
  3. Anna Renz1,
  4. Charles Vincent3
  1. 1Department of Surgery & Cancer, Imperial College London, London, UK
  2. 2Said Business School, University of Oxford, Oxford, UK
  3. 3Department of Experimental Psychology, University of Oxford, Oxford, UK
  1. Correspondence to Dr Anam Parand; a.parand{at}


Objectives To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care.

Design A systematic review of the literature.

Methods A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15 447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles.

Results The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals.

Conclusions There is some evidence that managers’ time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance.

  • Systematic literature review
  • Patient Safety
  • Leadership

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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