Table 2.

Focus group guide used during the study

Number:	End:	Transcription:
Date:	Moderator	Setting:
Start:	Observer	No. participants:
Five main questions	Topic lista
What is internal quality management and what is the role of the HEC herein?	Definition: – Quality assurance (PDCA cycle, performance measurements, performance evaluation, questionnaires) – Quality improvement (action, innovation, consolidation) – Internal auditing
	Internal quality management versus external quality management
	Parties involved: – Hospital board – HEC – Educationalists/advisors/supporting staff – Departments/teaching teams/clinical teachers – Residents – External coaches/parties
	Role of HEC: – Promote/stimulate/intervene/execute – Birds-eye view/monitoring – Policy making – Take responsibility/facilitate meetings
How do you feel about internal quality management?	Positive: – Good/important/enthusiastic/activating – Added value (improves quality of residency training) – Supportive to external quality management
	Negative: – Bad/takes time/necessity – Too much work/not useful – Hierarchical
What are achievements of internal quality management and the HEC’s effort?	Levels of impact: – Level of teaching hospital (hospital board, finances, HEC) – Level of departments (leadership, teaching teams, clinical teachers) – Level of residents (more residents, better residents, satisfaction) – Level of the patient (change in care)
	Achievements: – More awareness/attention/interest – Impact of HEC (meetings, content, collaborations, facilities, power, finance) – Education (better programs, development, innovations) – Patient care
What is needed to make internal quality management work? What impairs?	Needed: – Culture (collective vision, everybody on board, representatives, exchange of best practices) – Systems (routines) – Communication/collaboration/support – HEC power (right to intervene, freedom, trust)
	Impairing: – External pressure – Excess work – Compulsivity/coercion/pressure – Pressure to perform more patient care – Lack of finance/support – Content of some tools used in internal quality management
Are there remaining topics that were not discussed? What is your take home message?	– Innovations – Hospital merges – Large scale projects (building, expanding hospital) – Accreditation

^aThe topic list was used only after initial discussion of the main question. In line with the iterative approach adopted in the study, the topic list was adjusted (mainly extended) for each new focus group, based on topics addressed in previous focus groups. The topic list was used to introduce points for discussion that were not mentioned during initial discussion (to broaden the focus group discussion)