Abstract
BackgroundHospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited.Methods/DesignWe propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias.DiscussionProducts of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals.
Highlights
Hospitals in European countries apply a wide range of quality improvement strategies
In response to this debate a new research line related to the effectiveness of quality improvement emerged from the quality field in the last 10 to 15 years. This led to research questions such as “does quality improvement lead to better quality of care?”, “which quality tools are most effective?”, “how can various quality tools be integrated into a context-sensitive quality and safety improvement programme?” or “what factors impact on the implementation of quality strategies at hospital level?” [10,11,12,13]. These questions are of high relevance from the perspective of individual health care professionals and hospitals, which on the one hand have to comply with existing legislation and statutory regulation of quality improvement, but on the other hand have significant sovereignty to select from a range of quality tools to target organisation-specific quality and safety problems
Recent work addressed the impact of organisational quality improvement strategies on hospital patient safety and quality and supported the proposition that the scope of quality improvement implementation in hospitals is significantly associated with hospital-level quality indicators, even though the directions of the associations are not always systematically positive [12,13]
Summary
Hospitals in European countries apply a wide range of quality improvement strategies. Despite considerable progress in answering both questions and the widespread application of quality strategies (such as accreditation systems, organisational quality management programmes, audit, patient safety systems, clinical practice guidelines, performance indicators and systems for getting patient views), quality and safety problems persist and the debate on how to accelerate and sustain quality improvement is more relevant than ever [5,6,7,8,9] In response to this debate a new research line related to the effectiveness of quality improvement emerged from the quality field in the last 10 to 15 years. Professionals and hospitals alike are investing a lot of time and energy in quality improvement efforts, scientific evaluation of the various approaches, and a systematic effort to enhance knowledge and learning, is still limited
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