A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol

Abstract

Backgroundalthough there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them.The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients.Methods/designin-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features:• a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience• a conceptualisation of quality as a human, social, technical and organisational accomplishment• an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union.Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims).Discussionthe protocol is based on the premise that future research, policy and practice need to address the sociology of improvement in equal measure to the science and technique of improvement, or at least expand the discipline of improvement to include these critical organisational and cultural processes. We define the 'organisational and cultural characteristics associated with better quality of care' in a broad sense that encompasses all the features of a hospital that might be hypothesised to impact upon clinical effectiveness, patient safety and/or patient experience.

Quality of care in cystic fibrosis: assessment protocol of the French QIP PHARE-M

“…the organizational culture (see Table 8) and patient centeredness and leadership style (see Table 9); the alignment of the PHARE-M QIP with the hospital quality policy as described within the framework of the European QUASER study [20] using eight open questions in an interview with a head of the hospital quality department (see Table 10). …”

Designing new collaborative learning spaces in clinical environments: experiences from a children’s hospital in Australia

“…As a result, education, although it is recognised as valuable, often takes a back seat to clinical care and research. However, as hospitals are becoming increasingly aware of factors influencing quality and safety, the publication of these outcomes in benchmarking activities, and the need to attract and retain a highly competent workforce, the importance of education and professional development of staff has been evident (Aiken et al, 2012;Robert et al, 2011).…”

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada

“…This framework is one of the first that applies organizational theories to disentangle ‘the how’ of improving quality works [19,23]. It highlights common organizational domains important to address in considering whether a group has the capacity to and is ready to engage with a QI initiative when planning and implementing a QI initiative.…”