2. What are the requirements for participation in taking the HLQAT survey?
4. How do we know that the HLQAT works?
5. What are the Resources for Leadership Interventions (RLIs)?
6. What criteria were used to develop the RLIs?
7. What materials are available at HLQAT.org and is there a cost to access these materials?
8. What is the HLQAT Leadership Institute?
9. How do hospitals register to take the survey and receive their reports?
12. How does the HLQAT survey compare to the AHRQ patient safety culture survey?
13. How are the comparison values set in the Reference Group Comparison Report?
14. Is there an option to get more analysis beyond the standard reports on HLQAT.org?
The HLQAT survey was developed by the University of Iowa Department of Health Management and Policy, Health Services Advisory Group, Premier/Care Science and the Oklahoma Foundation for Medical Quality with input from Westat. The tool is designed as a gap assessment which, when coupled with the Resouces for Leadership Interventions, will provide a strategic roadmap to quality excellence.
The HLQAT consists of two distinct surveys for individuals working in two different groups of hospital leadership positions, Senior Leadership and Clinical Management (Members of the groups are designated below). Each questionnaire includes just over 100 questions that examine structures, processes, and leadership activities demonstrated to be associated with high performance in clinical quality in a hospital setting. It can be completed in about 30 minutes.
The HLQAT identifies 12 categories (or Domains) of leadership capacity and commitment that are correlated with high performance.
HLQAT Domains Include:2. What are the requirements for participation in taking the HLQAT survey?
In order to analyze the survey responses, as well as protect respondent anonymity, the analysis team will need to receive a certain number of responses from each hospital for each leadership category identified below: 3 board members, 4 members of the executive team (CEO, CMO, CNO, and CFO), and 6-10 clinical managers. Note that these are minimum numbers. We hope that a majority of respondents in each leadership category will participate. This will ensure that we are able to give individual hospitals a report containing their raw data aggregated by leadership category, i.e. Board, Executive Leadership, Clinical Management.
The analysis of the data from the survey responses will be shared in the aggregate only. The responses will be encrypted at the source. No individual hospital or respondent data will be shared outside the core research team. A hospital may receive its own aggregated raw data compared to the entire hospital aggregate sample, but again, no individual respondent data will be made available.
Senior Leadership Survey:
Hospital Board of Directors/Trustees/Governing Board
Chief Executive
Senior Administration/Management—Specific Individuals
Clinical Management Survey:
Physician Leaders:
Directors/Managers of clinical areas (non-physicians):
4. How do we know that the HLQAT works?
In the spring of 2008 the HLQAT was subjected to cognitive testing by a team of academics from The University of Iowa College of Public Health, Brandeis University, and the Leonard Davis Institute at the University of Pennsylvania, with assistance from Westat. Working collaboratively, researchers from these institutions conducted a series of pilot studies to determine the instrument's psychometric properties, item response variability, factor structure of the a priori leadership dimensions, and reliability of the dimensions themselves. A consultant was employed to analyze data from a web-based pilot of 58 hospitals across the U.S. which yielded a sample of 939 respondents. The pilot examined the association between hospital leadership attributes and performance by comparing high and low performers (upper and lower quartiles) using a composite clinical quality measure that included AMI, heart failure, pneumonia, surgical infections, and risk-adjusted mortality.
The analyses showed that four domains were significantly associated with hospital quality scores: knowledge-seeking organization; clearly defined QI leadership roles; collaborative, supportive culture; and interdisciplinary process improvement tools and techniques. Based on the psychometric analyses, HLQAT was revised into two versions, the first for C-suites and governing boards and the second for clinical managers.
5. What are the Resources for Leadership Interventions (RLIs)?
The RLIs are available online at HLQAT.org. The RLIs are quality improvement articles, tools, and other resources that recommend a course of action specific to a domain identified in the HLQAT assessment report. These technical assistance materials are closely aligned with the 12 HLQAT domains. In other words, the domains in which a hospital has opportunities for improvement are matched with the links in the RLI database that offer recommended resources for addressing those opportunities.
Three forms of RLIs are provided. A "Resource" is a website that contains a collection of information and/or tools to support an intervention. "Evidence" denotes an academic journal article or other research-based literature documenting improvement activities and results. Templates, sample statements, workbooks, and toolkits constitute "Tools" designed to support the implementation process. Several of the RLIs support improvement in more than one domain, such as improved communication skills or pathways.
The recommended RLI materials were developed by a volunteer review committee over a period of several months. Members of the committee include researchers from the University of Iowa College of Public Health as well as Premier, Inc. professionals working with hospitals directly to improve quality outcomes and Quality Improvement Organizations (QIOs) staff who consult in the area of patient safety and quality improvement.
Members of the volunteer RLI review committee include: Thomas Vaughn, Ph.D., Barry R. Greene, Ph.D., and Lee Singh, research assistant, University of Iowa College of Public Health; Eugene Kroch, Ph.D., and June Buckle, ScD, RN, with Premier, Inc.; Mark Koepke, JD, MHA, Kim Downs, RN, CPHQ and Angela Plusquellic, MBA with IFMC; and Shannon Archer, RN, BSN, CPHQ with OFMQ.
6. What criteria were used to develop the RLIs?
The following criteria are used for including resources in the RLIs database:
7. What materials are available at HLQAT.org and is there a cost to access these materials?
All materials/resources available at HLQAT.org will be made available to individual participating hospitals at no charge. Any hospital in the country will be able to access the HLQAT survey, the reports, and the evidence-based resources (RLIs) available on the website.
With the proper hospital codes, all of the hospital respondents (boards, executives and clinical leaders) will be permitted to complete the HLQAT instrument on-line.
Once the threshold of minimal responses (13 per hospital) is met, hospitals will be given access to the results for their specific institution as well as comparisons with reference hospitals at both the aggregate level and the level of the respondent constituency (boards, executives, and clinical leaders).
Hospitals will also be given access to a set of Resources for Leadership Interventions, over 120 on-line evidence-based resources (articles, tools and other resources) that have been evaluated for their value by a review committee of researchers and quality improvement experts and targeted to specific opportunities identified by the administration of the HLQAT.
8. What is the HLQAT Leadership Institute?
The HLQAT Leadership Institute is a non-profit applied research collaborative consisting of organizations interested in making the HLQAT available to any hospital in the United States that seeks to improve organizational quality culture and clinical outcomes. Consisting of representatives from The University of Iowa College of Public Health, IFMC (non-QIO work conducted by IFMC), the Institute for Healthcare Improvement, ActiveStrategy, and other organizations, the HLQAT Leadership Institute partners with QIOs and state hospital associations to provide resources and consultation based upon HLQAT-oriented assessments.
9. How do hospitals register to take the survey and receive their reports?
Any hospital that is interested in completing the HLQAT survey and receiving the reports and resources at HLQAT.org, must first register to receive a Welcome packet and a unique identifier codes. These codes will be used by participating hospital staff to login and complete the survey. The hospital survey administrator will also use a code to gain access to the reports. Registration requests can be submitted by sending an email with the subject line, "HLQAT Participant", to hlqat@ifmc.org.
Be sure to include the following information:
• Hospital name
• Designated survey contact (name, e-mail, phone)
• Hospital CEO contact (name, e-mail, phone)
• Number of beds
• System affiliation (if any)
10. Will other entities like state hospital associations and QIOs be able to view a hospital's performance report?
The information from a hospital's HLQAT survey is the property of the hospital. It may be helpful to share the results with the state QIO or hospital association if the hospital is engaged in quality improvement activities with these groups.
11. Is CMS planning to mandate the use of the HLQAT survey and require the public reporting of a hospital's results?
The HLQAT project management knows of no plans on the part of CMS to mandate the use of the survey for all hospitals or to publically report the results. Also, CMS, in keeping with federal law and regulations, does not endorse this or any other survey tool.
12. How does the HLQAT survey compare to the AHRQ patient safety culture survey?
The AHRQ survey complements and enhances the HLQAT. While the HLQAT assesses senior leader and clinical manager attributes and activities, the AHRQ survey dives deeper into the organization to look at the culture of safety inclusive of frontline staff.
13. How are the comparison values set in the Reference Group Comparison Report?
The Reference Group Comparison values show where the participating hospital ranks on HLQAT domains compared to all hospitals that have completed the HLQAT survey. The reference group will be re-calibrated on an ongoing basis as the pool of participants expands.
14. Is there an option to get more analysis beyond the standard reports on HLQAT.org?
Yes, Hospitals and other organizations are able to get additional analysis on their results. For example, many state hospital associations have set up their own custom comparison reports to help them prioritize their improvement efforts. Contact hlqat@ifmc.org for more info.
