Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BMC Health Services Research

Naomi Fulop³  Johan Calltorp²  Boel Anderson-Gare²  Anne Marie Weggelaar⁶  Francisco Nunes¹  Susan Burnett⁷  Christian von Plessen⁴  Karina Aase⁵  Siri Wiig⁵ 

[1] ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon 1649-026, Portugal;Jönköping Academy for improvement of Health and Welfare, Jönköping University, Box 1026, 551 11 Jönköping, Sweden;Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej, 29-3400 Hilleroed, Denmark;Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway;Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands;Imperial College, London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK

关键词: Quality improvement;    Multi-level case study;    Patient experience;    Patient safety;    Clinical effectiveness;    Quality conceptualization;   

Others  :  1125941
DOI  :  10.1186/1472-6963-14-478

 received in 2013-11-06, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Conceptualization of quality of care – in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study.

Methods

This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics).

Results

The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. ‘Quality’ in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided.

Conclusion

The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

【 授权许可】

   
2014 Wiig et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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