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PLoS One. 2013 Dec 31;8(12):e85662. doi: 10.1371/journal.pone.0085662. eCollection 2013.

The relationship between social capital and quality management systems in European hospitals: a quantitative study.

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Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America ; University of California Los Angeles Center for Health Policy Research, Los Angeles, California, United States of America.
Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America.
School of Social Policy, HSMC, University of Birmingham, Birmingham, United Kingdom.
NIVEL, Nederlands instituut voor onderzoek van de gezondheidszorg, Utrecht, The Netherlands ; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain ; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), Spain.



Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups.


We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals.


We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering.


The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029).


The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.

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