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Studying Quality and Safety in European Hospitals - QUASER. Prof Naomi Fulop Dr. Janet Anderson NIHR King’s Patient Safety and Service Quality Research Centre. 9 th June, 2010. Background: EU Policy. Right of patients to seek healthcare in another Member State

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Studying Quality and Safety in European Hospitals - QUASER

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Studying Quality and Safety in European Hospitals - QUASER

Prof Naomi Fulop

Dr. Janet Anderson

NIHR King’s Patient Safety and Service Quality Research Centre

9th June, 2010

Background: EU Policy

  • Right of patients to seek healthcare in another Member State

  • Directive on safe, high quality and efficient cross-border healthcare (2008) – one of main goals:

  • “Patients should be confident that the quality and safety standards of the treatment they will receive in another Member State are regularly monitored and based on good medical practices”

"Study the relationship of organisational quality management and culture, professionals' involvement, and patient empowerment with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement.

Identify organisational and cultural characteristics of hospitals and professional- and patient-related tools that are associated with better quality of care.

This research should serve to guide hospitals to develop their own effective safety and quality improvement programmes and provide the basis for assessing hospital quality of care by purchasers and national and local governments.

Funding scheme: Collaborative Project (Small or medium-scale focused research project)."

Background: EU 7th Framework Programme Call on Quality and Safety

Two proposals funded


  • DuQue – builds on MARQuIS study (QSHC, 2009)

  • further develop ‘maturity classification model’

  • focus on associations between this model &

    • measures of org culture, prof involvement and pt empowerment

    • measures of clinical effectiveness, patient safety and patient involvement

QUASER – Overall Aim

  • To explore relationships between organisational and cultural characteristics of hospitals and how these impact on clinical effectiveness, patient safety and patient experience in European countries

QUASER - Objectives

  • To design and disseminate the Quality and Safety Guide for Hospitals – assist hospitals to implement quality and safety programmes

  • To design and disseminate the Framework for Assessing Hospital Quality – assist purchasers of hospital services and governments to assess quality of hospital care

QUASER - Partners

  • Patient Safety and Service Quality Research Centre, King’s College London, England

  • Erasmus University, Netherlands

  • Jönköping County Council, Sweden

  • Centre for Patient Safety and Service Quality, Imperial College London, England

  • ISCTE, Portugal

  • University of Stavanger, Norway

QUASER - Stakeholders

  • Stakeholder group – hospitals and payers from:

    • Spain

    • Romania

    • Turkey

    • Denmark

    • Poland

    • Estonia

    • Norway

    • Netherlands

    • Sweden

QUASER – key features of study

  • Quality as a human and social accomplishment, not just technical

  • Multi level, longitudinal study – focus on the interactions between the macro, meso and micro levels and their effect on quality

  • Translational research – translate research into outputs with relevance, utility and value.

QUASER – conceptual approach

  • Start with the practice

  • What are people doing, or not doing in terms of quality improvement at the hospital level and at the bedside?

  • What are the rationales that are driving their day-to-day practice?


Six Sigma

Plan do study act

Clinical governance

Risk management

Specific tools and strategies


Surgery checklist

Standardised care pathways

QUASER – conceptual approach

Good understanding of types of quality improvement strategies - examples

QUASER – conceptual approach

  • Less understanding of the factors that increase effectiveness of these

  • Less understanding of longitudinal factors – the quality journey and building capacity

  • Quality is not just technical, it has human and social components

    • Leadership

    • Organisational culture

    • Team based structures

    • Organisational structures and processes

QUASER – Key questions

  • What cultural factors influence the success of quality improvement efforts at different levels of the system?

  • How do these factors relate to one another?

  • How do hospitals influence these factors?

  • How is quality improvement carried out day to day?

  • How are challenges in implementing quality improvement overcome?

  • How do high and low performing hospitals differ in terms of culture, leadership, management structures?

QUASER Work Packages

QUASER Work Packages cont….

QUASER Management Structure

QUASER Management Structure

  • Consortium meetings – include all researchers. Meet annually to review progress

  • Project Management Board meetings – via phone. Need to determine how often to meet

  • Expert advisory board – timing of first meeting

  • Work package leaders – need to arrange communication with work package boards

QUASER team responsibilities

  • Active participation in work package boards

  • Timely completion of work

  • Responsive to communication and requests from others

  • Attendance at meetings

QUASER – links with DUQUE project

  • Prof. Fulop is a member of the advisory board

  • Intend to invite DUQUE participation in QUASER advisory board

  • Potential for further collaboration - eg:

    • Joint outputs

    • Hospital selection in Portugal and England

    • Use of their maturity framework for selection

    • Joint dissemination activities

Links with other research groups

  • Taiwan Medical University and WanFang Hospital Taipei

    • Invited to present QUASER project at International Patient Safety Workshop, Taipei, December, 2009

    • Interested in participating as stakeholder organisations

    • Interested in replicating study in Taiwan (self funded)

    • Meeting June 28th to discuss further

QUASER next steps

  • Official start date – 1st April 2010

  • Will need to request extension

  • Progress on recruitment in London

    • Interviews for Project Manager, Research Fellow (KCL) and Research Associate (IC) on June 17th

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