Implantation d’une démarche qualité dans les services médicaux d’un hôpital universitaire : facteurs d’accélération et de frein

Abstract

Background The aims of this study were to assess the level of implementation of continuous quality management program and to identify the factors associated with its failure in the medical departments of a teaching hospital. Methods Semi-directive interviews were conducted with 52 hospitalists, including 16 department heads and 36 staff members in charge of quality management, in 30 medical departments that implemented a continuous quality management program from 1998 to 2002. The interviews were analyzed using a manual thematic method and a computerized semantic method. Results At the study endpoint (i.e., 2003), the continuous quality management program was still working in six departments and was stopped in 24 departments. The professionals complied with the model of intervention based on the identification and the resolution of department problems by multiprofessional working groups. The main external factors associated with the failure of the continuous quality management program included shortage in staff and the lack of time to devote to this activity. In addition, professionals cited the defect of commitment by the top management, the lack of acknowledgment of their efforts, and the hospital accreditation as factors with negative impact on staff motivation. The main internal factors associated with the failure of the continuous quality management program were related to the leadership in quality management. The personal involvement of the department head played a key role in the continuation of the quality management program. Most of the staff regretted the lack of involvement of the physicians and stated that methodological support was needed. Conclusion The implementation of quality management in the medical departments remains difficult in the absence of institutional support. The leadership within the department plays a major role in the continuation of the process.