The Mixed-Method 5W2D Approach for Health System Stakeholders Analysis in Quality of Care: An Application to the Moroccan Context.

Frichi Frichi,Jawab Jawab,Boutahari Boutahari

doi:10.3390/ijerph16162899

Abstract

(1) Background: Quality of care (QC) is not only about satisfying patients, but also about satisfying the various health system stakeholders (HSS). This makes it a complex and difficult objective to achieve. This study aims at proposing a methodological framework for identifying HSS, prioritizing them in QC, and analyzing their interrelationships. (2) Methods: The proposed framework is the mixed-method 5W2D approach, which uses a combination of three basic methods: the 5W questioning technique (What, Who, Why, Where, and When), the Delphi method, and the Decision making trial and evaluation laboratory (DEMATEL) technique. It consists of three interdependent phases. First of all, a preliminary list of HSS is established based on a systematic literature review, which is then projected and adapted to the national context using the 5W questioning technique. Secondly, the identified HSS are classified in order according to their influence and impact on QC by employing Delphi method. Thirdly, the interrelationships between HSS are determined and analyzed by applying DEMATEL technique. An application of 5W2D is conducted in the Moroccan context as its health system involves a wide range of stakeholders. (3) Results: Results defined 17 groups of HSS, whose prioritization led to three groups that are at the core of the health system: patients and their families, health personnel, and government. Roles and expectations of these groups regarding QC are divergent and contradictory, which require making trade-offs. The findings of this study intend to guide the development of inclusive strategies and policies that involve key stakeholders for QC assessment and improvement.

Highlights

Quality issues have grown to be a major concern for almost all organizations; quality improvement can help at reducing costs and delays, as well as promoting the organization’s image and reputation.In the health sector, healthcare facilities are required to improve the quality of care (QC), which should be developed to best fit the general standards and regulations and meet the patients’ needs [1]
(3) Results: Results defined 17 groups of health system stakeholders (HSS), whose prioritization led to three groups that are at the core of the health system: patients and their families, health personnel, and government
QC is a complex concept because of the multitude of stakeholders who play essential roles in the inputs, processes, and outputs of healthcare services. It is influenced by the stakeholders who make up the health system

Summary

Introduction

Quality issues have grown to be a major concern for almost all organizations; quality improvement can help at reducing costs and delays, as well as promoting the organization’s image and reputation.In the health sector, healthcare facilities are required to improve the quality of care (QC), which should be developed to best fit the general standards and regulations and meet the patients’ needs [1]. QC is a complex concept because of the multitude of stakeholders who play essential roles in the inputs, processes, and outputs of healthcare services. It is influenced by the stakeholders who make up the health system. Its assessment should consider the perspectives of the service recipients (patients), as well as the direct and indirect healthcare service providers (health professionals and managers) [2] In this respect, Leviton and Melichar [3] claim that improving QC requires taking into consideration the perspectives of stakeholders that are essential for planning, implementing, and assessing QC. The United States National Academy of Medicine (NAM) defined QC as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes, and are consistent with current professional knowledge” [11]

Methods

Discussion

Conclusion