What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence

Abstract

There is a widely held view that good management improves organizational performance. However, hospitals are complex organizations, and the relationship between management practices and health service delivery is not straightforward. We conducted a global, systematic literature review of the quantitative evidence on the link between the adoption of management practices and quality of care in hospitals. We searched in PubMed, EMBASE, EconLit, Global Health, and Web of Science on 16 October 2024, without language or country restrictions. We included empirical studies from 1 January 2000 onwards, examining the quantitative association between hospital management practices and quality of care. Outcomes included structural quality (availability of resources such as drugs and equipment), clinical quality (adherence to guidelines), health outcomes, and patient satisfaction or experience with care. In every study, each tested association was categorized as significantly positive (at the 5% level), null, or significantly negative. The study was registered with PROSPERO (CRD42022301462). Of 11 731 articles, 25 studies met the inclusion criteria and had an acceptable risk of bias. Studies were equally distributed between high-income and low- and middle-income countries, with 22 cross-sectional and three intervention studies. Of 111 associations, 55 (49.5%) were significantly positive, one (1%) was significantly negative, and 55 (49.5%) were null. Among the associations tested, the majority were significantly positive for structural quality (79%), clinical quality (60%), and health outcomes (57%), while most associations between hospital management and patient satisfaction (80%) were null. The findings are mixed, with a similar proportion of positive and null associations between management practices and quality of care across studies. The evidence is limited by the risk of bias introduced by nonrandomized study designs. Evidence of positive associations in some settings warrants further investigation of the association through intervention studies or natural experiments. This could leverage methodological developments in quantitatively measuring management, highlighted by this review.

Keywords: health systems; management practices; quality of care; systematic review.

Figure 1.

PRISMA 2020 flow diagram.

Figure 2.

Management–quality associations, by income setting.

Figure 3.

Management–quality associations, by type of quality of care outcome.

Figure 4.

Management–quality associations, by risk of bias categorization.

Figure 5.

Management–quality association, by sector.