A research project on different quality assurance strategies and their effect on improvement of care with respect to four clinical topics:
- keeping of patient records
- prophylactic antibiotic use in surgery
- preoperative assessment
- prevention and therapy and bedsores.
A Concerted Action Programme on quality assurance (QA) in hospitals involved a multicentre comparative study on different quality assurance strategies and their effect on improvement of care with respect to:
keeping of patient records;
prophylactic antibiotic use in surgery;
prevention and therapy of bedsores.
Existing activities on quality assurance, executed by hospital management, medical staff and nursing staff, were assessed by means of a questionnaire. A total of 262 hospitals in 15 countries have participated. On the topics of recordkeeping, prophylactic antibiotic use in surgery, preoperative assessment and prevention and therapy of bedsores, quality assurance studies were initiated. These studies were based on a common methodology described in information packages. An evaluation will be executed to assess the effectiveness of strategies used for implementation of the QA studies and of the actual effects.
The following factors were found to influence the implementation of QA:
support by national organizations of professional or hospital manager;
role of country coordinator as a change agent;
physicians, nurses and managers that acted in the hospital as a change agent;
support of respected peers;
support of professionals by hospital management;
awareness of quality assurance concepts and methods by a sufficient number of persons in the hospital and willingness to perform activities;
knowledge about how to execute a QA study;
sufficient availability and access to information on patient care;
sufficient skills and energy to fully implement changes after a study has been executed.
Apart from being a research project, the project tried to be supportive to the implementation of quality assurance activities in different hospitals in the participating countries.
This is done through a three phase study design:
- a pre-assessment phase in which the base-line situation with regard to quality assurance activities in the participating centres was studied; in general and more specific in relation to the four clinical topics mentioned above;
- an action phase in which the hospitals were asked to perform a quality assurance study on two of the four clinical topics in their own institution. Packages with detailed background material on the methodology of quality assurance studies, the four specific topics and the introduction of change in hospitals were provided;
- an evaluation phase to evaluate the effects of the action phase; compare the situation in the hospitals with the results found during the pre-assessment phase, evaluate the implementation strategies used and evaluate the results of the local QA studies.