Bridging Competencies and Outcomes: An Empirical Study of Healthcare Quality Improvement Framework

Healthcare organizations face increasing pressure to improve quality outcomes while managing limited resources effectively. While the National Association for Healthcare Quality (NAHQ) has developed a framework for healthcare quality competencies, the relationships between these competencies and organizational performance remain unclear. In this article, we investigate how different quality competencies collectively and individually influence healthcare organizational performance through the lens of stakeholder theory. We integrate the NAHQ competency framework with the Baldrige Excellence Framework to develop and test a theoretical model linking quality competencies to organizational outcomes. Survey data from 152 healthcare professionals in the United States were analyzed using partial least squares structural equation modeling. Contrary to the conventional expectations, the results show that neither quality leadership nor health data analytics directly improves organizational outcomes. Instead, their enabling effects work through a set of legitimacy-oriented competencies as essential mediators. Specifically, the findings reveal that the competency of quality leadership and integration significantly influences both health data analytics and legitimacy-oriented competencies. While health data analytics shows no direct effect on quality results, it significantly enhances legitimacy-oriented competencies, which in turn strongly influence quality outcomes. A series of robustness checks, including bias assessments for the survey method, construct reliability and validity checks, and control variable analysis based on healthcare professional experience levels, were conducted to validate the results. The findings suggest that healthcare organizations should focus on developing integrated quality capabilities rather than pursuing isolated improvements, as the impact of both leadership and analytics capabilities on organizational performance is primarily mediated through other operational competencies. This research contributes to healthcare quality management theory and provides practical guidance for healthcare leaders on effectively allocating resources across different competency domains.