Staff involvement is essential to success of hospital quality systems

Implementing quality systems in hospitals leads to better quality of care over time. But hospitals could reap even greater benefits if they more frequently used their organisational outcomes to learn and make improvements. They also have to make sure health care professionals continue to be involved in the quality policy and its implementation, because without their involvement, the quality system will not have the desired effect. This has emerged from research conducted at the Netherlands Institute for Health Services Research (NIVEL) by Steffie van Schoten for her doctoral thesis. She received her PhD from VU University Amsterdam on November 4.

Since 1996, all health care institutions in the Netherlands are required to have a quality system in place. Although quality systems are intended to ensure and improve quality of care, no conclusive evidence for this has yet been found. Steffie van Schoten’s research focused on whether hospital quality systems really do contribute to quality of care. An analysis of fifteen years of quality management in Dutch hospitals has shown that although nearly all hospitals have implemented the various elements of quality systems, less than half use the outcomes to learn and make improvements. Of all of the different elements, patient involvement is the least developed.
Better outcomes?
An analysis of the results that have emerged from working with quality systems over the past fifteen years has shown that hospitals with more developed systems have better outcomes. In addition, these outcomes can, in turn, contribute to improvements to the quality system itself, thus creating a continuous improvement cycle. However, no evidence was found that quality systems contribute to improvements in care processes.
Involvement of health care professionals is essential
Interviews with health care professionals revealed that they often feel overwhelmed by the number of rules and procedures imposed by the quality system, and find it hard to see how they relate to quality of care. The involvement of health care professionals is essential if quality systems are to function optimally. Therefore, it is important to keep them involved in future by making better use of feedback from these professionals about the feasibility of rules and procedures in actual practice.
Van Schoten based her results on research conducted in Dutch hospitals that made use of questionnaires administered to quality managers and health care professionals, observations of care processes, patient record reviews, and interviews with health care professionals.

Ministry of Education, Culture and Science
Ministry of Health, Welfare and Sport