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Introduction
Hospitals aim to ensure consistently safe, high-quality care, but this remains a challenge in public hospitals in Australia and around the world. Healthcare is a complex, high-risk industry, with many steps and people involved in the simplest care episode (Plsek and Greenhalgh, 2001). Problems with safety of care in key areas such as infections and medications persist, and evidence-based guidelines are inconsistently applied (Classen et al., 2011; Runciman et al., 2012). Quality programmes have evolved slowly, limited by lack of consistent focus, data and resources and minimal attention paid to this aspect of the professional role in clinical education (Balding, 2008). A recent review of approaches to improving quality in the NHS found that quality improvement (QI) was still a stated priority, but that gaps in leadership, complex organisational arrangements, inconsistent approaches to measurement and accountability and insufficient attention to the skills needed to make change happen had weakened implementation (Molloy et al., 2016). There is evidence that management turnover may be a factor that has contributed to this disappointing implementation of hospital quality systems (Mosadeghrad, 2014). This paper reports on a longitudinal study of quality management in public hospitals in Australia. In particular, we explore the relationship between high levels of turnover among management and governing board members and quality management.
Background
Resource-based theory links organisational performance to necessary organisational resources, such as leadership (Barney, 1991) and therefore explains the strong evidence of an association between leadership by top management and QI success (Kaplan et al., 2010). Consequently, frequent chief executive officer (CEO) turnover may have negative effects on the ability of a health service to achieve QI objectives. For example, studies in nursing homes have consistently found a relationship between top management turnover and both implementation of QI initiatives (Rantz et al., 2012), and the actual quality of care (Castle and Lin, 2010; Decker and Castle, 2011). It was suggested that top management turnover resulted in fragmented values, lack of a shared vision among the staff and desensitisation of staff to management guidance, which ultimately resulted in deteriorating care provision (Hunt et al., 2014). These findings are consistent with evidence from other industries, which suggests that high levels of change in leadership lead to the lack...