Table 2.

The organising for quality framework

Bate, Mendel and Robert [24] undertook a three-year international study that was explicitly designed to help practitioners and researchers understand the factors and processes that enable hospitals in the US and Europe (England and the Netherlands) to achieve-and sustain-high quality services for their patients. This original study took as its starting point that whilst technical factors, such as information systems, do play a major role in accounting for the quality ‘gap’, organisational and cultural factors are crucial in understanding how quality and safety improvement occurs. Based on in-depth, multi-level case studies of seven leading hospital, this research found that high-performing hospitals were able to achieve, and then sustain, high levels of quality because they recognised and had been extremely successful in addressing-on an ongoing basis-six common challenges. The six common challenges that were identified from the case studies were:

1. structural - organising, planning and co-ordinating quality efforts

2. political - addressing and dealing with the politics of change surrounding any QI effort

3. cultural - giving ‘quality’ a shared, collective meaning, value and significance within the organisation

4. educational - creating a learning process that supports improvement

5. emotional - engaging and mobilizing people by linking QI efforts to inner sentiments and deeper commitments and beliefs

6. physical and technological - the designing of physical systems and technological infrastructure that supports and sustains quality efforts

The researchers represented these common challenges by means of a ‘codebook’ which took the form of a checklist that practitioners can use to identify where the organisational gaps in their local improvement efforts may lie and what they may need to do to address them.

Source: QUASER research protocol [24]