Abstract
BackgroundQuality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy.ObjectiveFirst, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy.MethodsIn this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed.ResultsQI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents.ConclusionsHospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up.
Highlights
Across all levels of healthcare, from micro- to macrosystems, initiatives to improve quality have been globally arising [1]
To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up
Data on public reporting was provided by the Flemish Institute for the Quality of Care (VIKZ), which is responsible for the measurement and the public reporting of quality indicators [24]
Summary
Across all levels of healthcare, from micro- to macrosystems, initiatives to improve quality have been globally arising [1]. In Flanders, the Dutch-speaking region of Belgium, a government agreement that forms the basis of today’s ‘Quality-of-Care Triad’ for the hospital setting was established in 2009. This Triad encompasses 1) voluntary announced hospital-wide accreditation, defined as an assessment of a pre-determined set of standards [6] by an international external agency, 2) voluntary measurement and public reporting of quality indicators and 3) mandatory inspection by the Flemish government. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Questions are raised on the sustainability of the present policy
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