A decade of commitment to hospital quality of care: overview of and perceptions on multicomponent quality improvement policies involving accreditation, public reporting, inspection and pay-for-performance

Abstract

Background Quality 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. Objective First, 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. Methods In 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. Results QI 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. Conclusions Hospitals 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.

Cornerstones of a sustainable national quality policy: A qualitative study based on international expert opinions

“…Since 2016, acute-care hospitals in Flanders demonstrated increased effort into these triad components. 12 However, a recent review has shown the lack of evidence for all three 'Quality-of-Care-Triad' components. 13 Furthermore, hospitals and healthcare stakeholders are critical about the sustainability of today's quality policies and voices are rising worldwide for a new approach for future quality of care initiatives.…”

“…This agreement introduced a ‘Quality‐of‐Care Triad’ consisting of three main components: voluntary hospital‐wide accreditation by an international external agency, voluntary measurement and public reporting of quality indicators as well as mandatory inspection by the government with an announced and unannounced part. Since 2016, acute‐care hospitals in Flanders demonstrated increased effort into these triad components 12 . However, a recent review has shown the lack of evidence for all three ‘Quality‐of‐Care‐Triad’ components 13 .…”

A co-creation roadmap towards sustainable quality of care: A multi-method study

“…Healthcare organisations worldwide have been initiating quality improvements and building a foundation for quality by applying many theories, methodologies and interventions [ 5 , 6 ]. In Flanders, Belgium, accreditation, public reporting and governmental inspection have been the main pillars for the development of hospital’s quality management system [ 7 ].…”

The cost of a first and second hospital-wide accreditation in Flanders, Belgium

“…Since 2009, the government of Flanders (a 6-million population region in Belgium) based its hospital quality of care policy on a triad consisting of voluntary accreditation by an external agency, mandatory inspection by the Flemish authorities and voluntary public reporting of quality indicators [8]. Almost all (98%) Flemish hospitals have obtained an accreditation label from JCI or Qualicor by now.…”

“…Almost all (98%) Flemish hospitals have obtained an accreditation label from JCI or Qualicor by now. The decision for accreditation is made by the hospitals and all associated costs are paid by them, with limited governmental financial support [8]. When successful, the hospital is granted a quality label valid for a defined period in time, after which it can apply for accreditation renewal.…”