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How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.

Leemans, K., Block, L. van den, Stichele, R. Vander, Francke, A.L., Deliens, L., Cohen, J. How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation. European Journal of Palliative Care: 2015 201. Abstracts. 14th World Congress of the European Association for Palliative Care: Building Bridges. 8-10 mei 2015, Copenhagen.
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Background
There is an increasing demand for the use of quality indicators in palliative care in order to monitor the quality of care.

Aim
With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation.

Methods
Three focus group interviews were organised with 21 caregivers from 18 different specialised palliative care services in Belgium. Four had already worked with the indicators during a pilot study. The focus group discussions were transcribed verbatim and analysed using the thematic framework approach.

Results
The caregivers anticipated that a positive attitude by the team towards quality improvement, the presence of a good leader and the possible link between quality indicators and reimbursement might facilitate the implementation of quality indicators in specialised palliative care services. Other facilitators concerned the presence of a need to demonstrate quality of care, to perform improvement actions and to learn from other caregivers and services in the field. A negative attitude by caregivers towards quality measurement and a lack of skills, time and staff were mentioned as barriers to successful implementation.

Conclusion
Palliative caregivers anticipate a number of opportunities and problems when implementing quality indicators. These relate to the attitudes of the team regarding quality measurement, the attitudes, knowledge and skills of the individual caregivers within the team and the organisational context and the economic and political context. Training in the advantages of quality indicators and how to use them is indispensable, as are structural changes in the policy concerning palliative care, in order to progress towards systematic quality monitoring.

Funding
This study is realised with the support of ‘Kom Op Tegen Kanker’, a campaign of The Flemish League Against Cancer.