From qualitative reflection to reflexive quality: an intersectoral approach to quality of care

Abstract

Background: All over the continent, organizations in healthcare and welfare are increasingly being challenged to be transparent about what they are doing and to provide evidence regarding the results they achieve. Some organizations choose to develop policy and practice based on a variety of indicators and strictly scientifically based criteria. In this perspective, quality of care is measured against the background of those standardized indicators. Other organizations consider care as a craft or even an art which is impossible to capture in strictly standardized norms and indicators. In such organizations, scientific knowledge is often seen as subordinate to the experiential knowledge of service users and practical knowledge of staff members. Hence, quality of care is measured by – amongst other things – proximity and involvement with service users.
 Within Emmaüs vzw, an organization that overarches a variety of facilities in the fields of healthcare and welfare in Belgium, forces were joined to develop a new framework for quality of care in which an effort is made to transcend the contradiction that is outlined above. In order to do so, the experiential knowledge of service users, the practical knowledge of staff and research based knowledge were combined and considered to be equally valuable in tackling issues regarding quality of care.
 The project: Building on participatory action research with service users, their social context, staff members, policy makers and academics, we co-constructed a value-driven and intersectoral framework for quality of care that is underpinned by rhizome theory (Guattari & Deleuze, 2014). The ecological approach to quality of care entails an effort to capture and do right by the complexity that characterizes the fields of care and welfare. Furthermore, we connected the concepts of quality and reflexivity in a meta-model that can be used to fuel quality improvement across healthcare en welfare organizations. In our project, service users and staff were involved as respondents and as co-researchers. We use the CAIMeR theory (Blom & Morèn, 2010) as an analytical framework to describe processes of change and to capture effective practice. Although the project is still ongoing, our research shows that the intersectoral framework is widely accepted across organizations in youth care, mental healthcare, elderly care and support of people with disability. Recently also a general hospital expressed their interest in our intersectoral framework and reflexive meta-model.
 Presentation: We will present the highlights of our co-constructed framework for quality of care and the reflexive meta-model that is currently piloted in different organizations.
 Learning objectives: After this session, participants will be able to:
 
 Understand how participatory action research can help further policy and practice on quality of care across healthcare and welfare organizations.
 Understand how the reflexive meta-model we developed can be used in practice.