Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

OBJECTIVE Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. DESIGN This is a retrospective questionnaire-based survey. SETTING All medical centres, regional hospitals and district teaching hospitals in Taiwan. PARTICIPANTS Directors or persons in charge of implementing QI methods in hospitals. INTERVENTIONS None. MAIN OUTCOME MEASURES The breadth and depth of QI method implementation. RESULTS Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. CONCLUSIONS In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour.