In 2005, researchers at the University of Iowa developed the Hospital Leadership and Quality Assessment Tool (HLQAT) to better understand the role of hospital leadership and governance in quality.

The HLQAT consists of two surveys:

  • A senior leadership survey for the C-suite and board members
  • A clinical management survey for clinical managers

Both surveys cover 12 domains capturing a variety of quality improvement practices and perceptions, such as public reporting of data and clearly defined quality improvement leadership roles. A hospital’s individual board, C-suite, and clinical manager scores are calculated by totaling the individual surveys from each category.

Through a grant from The Commonwealth Fund, the HLQAT was administered in 2008 to more than 600 hospitals and more than 9,000 individuals. When examining the relationship between hospital HLQAT scores and hospital quality outcomes, as defined by a composite of the Centers for Medicare & Medicaid Services’ (CMS’) core measures, two findings jumped out:

  1. Regardless of which respondent group was considered (board, C-suite, or clinical managers) hospitals with more positive perceptions on the HLQAT domains also had higher quality scores.
  2. Differences in the average domain responses between board, C-suites, and clinical managers were smaller for higher performing hospitals than lower performing hospitals. In other words, when clinical and executive leaders had similar perceptions of the HLQAT domains as they pertained to their hospital, they often had better quality performance.

The HLQAT in Action

In 2012, members of the Essential Hospitals Engagement Network (EHEN) took the HLQAT to help guide their collaborative work on reducing hospital-acquired conditions and preventable readmissions as part of the national Partnership for Patients Hospital Engagement Network initiative. In a follow-up administration of the HLQAT in 2013, the EHEN saw improvement in average HLQAT domain scores.

At the same time, the EHEN reduced harm in multiple areas, including 40 percent reductions in central line-associated blood stream infections (CLABSI) and hospital-acquired pressure ulcers (HAPU). These reductions would not have been possible without leaders placing harm reduction as a clear priority and allocating the necessary resources to improve clinical processes and the culture. The EHEN’s Leadership for Safety Program helped ensure leaders had the skills necessary to just that.