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Quality and Safety in European Union Hospitals

A Research-based Guide for Implementing Best Practice and a Framework for Assessing Performance (QUASER)


Funded by the EU Seventh Framework Programme (FP7). April 2010 - June 2013.

Contact: Prof Naomi Fulop

This three-year study explored the relationships between the organisational and cultural characteristics of hospitals, and how these impacted upon clinical effectiveness,  patient safety and patient experience in European Union countries. Co-ordinated by the Department of Applied Health Research, UCL, partners included the Imperial Centre for Patient Safety and Service Quality (CPSSQ); the Department of Health Studies at the University of Stavanger, Norway; the Department of Health Policy & Management, Erasmus University, Netherlands; Qulturum, Jönköping County Council, Sweden; ISCTE – Instituto Universitario de Lisboa, Lisbon, Portugal; King's College London, UK.

The key objectives of the project were to identify organisational and cultural characteristics linked to the effectiveness, safety and patient experience of hospital care, and the quantitative and qualitative indicators of this. Data was collected in 10 hospitals in the five partner countries (two in each of the five partner countries), with additional studies of two clinical microsystems in five of these (one in each of the partner countries).

Whilst there is a good understanding of the types of quality improvement undertaken in healthcare, less is known of the organisational and cultural processes that determine the effectiveness of these methods. By examining the relationship between these processes and quality from macro (national healthcare system) down through the meso (hospital) to micro (frontline clinical team) levels in each of the five partner countries, the study unveiled how the dynamics and interactions between these different levels impacted on sustained quality of hospital care.

This research enabled the team to deliver effective products to hospital leaders, based on the realities of implementing quality improvement programmes, and findings were used to design and disseminate an evidence-based Quality and Safety Guide for Hospitals. This will be a 'best practice' framework to guide hospitals on implementing effective organisation-wide quality and safety improvement initiatives. A Framework for Assessing Hospital Quality was also compiled, enabling purchasers of hospital services and governments throughout the EU to monitor and assess the effectiveness, safety and patient experience of hospital care.

Invited conference presentations

Other conferences

*** Download the QUASER Guide for Hospitals: A research-based tool to reflect on and develop your quality improvement strategies and the QUASER Guide for Payers: A research-based tool to assess and facilitate quality improvement strategies in hospitals ***

(You will need a pdf reader such as Adobe to open the Guides)

Project partners & their contact details:-

  • Department of Applied Health Research, UCL (Coordinator) - Professor Naomi Fulop, n.fulop@ucl.ac.uk

Publications:-

Robert, G. Anderson, J. Burnett, S. Aase, K. Andersson-Gare, B. Bal, R. Caltorp, J. Nunes, F. Weggelaar, AM. Vincent, C. Fulop, N. (2011) A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol. BMC Health Services Research 2011, 11:285. PubMed

Susan Burnett; Anna Renz; Siri Wiig; Alexandra Fernandes; Anne Marie Weggelaar; Johan Calltorp; Janet E. Anderson; Glenn Robert; Charles Vincent; Naomi Fulop. Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries.  International Journal for Quality in Health Care 2013; doi: 10.1093/intqhc/mzs079

Wiig, S., Storm, M., Aase, K., Gjestsen, M.T., Solheim, M., Harthug, S., Robert, G., & Fulop, N. & QUASER team. Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality? BMC Health Services Research 2013, 13:206 http://www.biomedcentral.com/1472-6963/13/206

Invited Conference presentations:-

2013

Fulop, N. (2013). Studying Quality and Safety in European Hospitals – QUASER: Understanding organisational and cultural factors influencing the implementation of QI systems. NHS Confederation Annual Conference. Held 5th-7th June Liverpool, UK.

Fulop N. (2013). Understanding quality and safety in European hospitals (QUASER): Understanding organisational and cultural factors influencing the implementation of QI systems. Presented at the Patient Safety Congress. Held 21st -22nd May, Birmingham, UK.

Fulop, N. (2013). Lessons from Europe - QUASER project. Presented at the Chief Executive’s Summit, Human factors and whole organisation culture. Patient Safety Congress. Held 21st -22nd May, Birmingham, UK.

Fulop, N., Groene, O., Portugal, R., Duuren, N., & Braut, G.S. (2013). Q & A panel with QUASER’s European partners. Presented at the Patient Safety Congress. Held 21st -22nd May, Birmingham, UK.

Bal, R. & Duuren, F. (2013). The role of the payers in improving safety and quality. Roundtable workshop. Presented at the Patient Safety Congress. Held 21st -22nd May, Birmingham, UK

Calltorp, J. (2013). The role of data in improving safety and quality. Roundtable workshop. Presented at the Patient Safety Congress. Held 21st -22nd May, Birmingham, UK

Wiig, S. & Braut, G.S. (2013). The role of regulators in improving safety and quality. Roundtable workshop. Presented at the Patient Safety Congress. Held 21st -22nd May, Birmingham, UK

Fulop N., & Burnett, S. (2013). Quality and Safety in European Union Hospitals: the QUASER project. International Improvement Science Symposium. BMJ International Forum on Quality and Safety in Healthcare. Held 16th-19th April, London, UK.

Charles, K. (2013). How can we support the development of quality improvement? The QUASER leadership guide. Presented at Spread and Sustainability Workshop, NHS Education for Scotland. Held 22nd February, Edinburgh.

Anderson, J. (2013). Quality and Safety in European Hospitals – QUASER. Understanding organisational and cultural factors influencing the implementation of QI systems. Geary Institute Seminar, University College Dublin. Held 22nd January, 2013.

2012

Fulop, N. (2012). Managing quality and safety improvement in European hospitals: Lessons from the QUASER. European workshop on risk management for patient safety. Held 21st November, in Brussels. Organised by DNV.

Fulop, N. (2012). Improving quality and safety: why studying organisational and cultural processes is important – the QUASER study. From policy to practice: An international comparison of approaches to systemic quality and safety. Workshop sharing results with policy makers and practitioners, Dublin City University Business School. Held 1st November 2012, Dublin.

Burnett, S. (2012). Patient safety policy into practice: Experience in England with lessons from a study across 5 European countries. Improving Patient Safety seminar organised by French Ministry of Health. Held 26th October 2012, Paris.

Burnett, S. (2012). Managing Quality in Healthcare: the Challenges for Hospital Leaders in Europe. Providing high-quality public services in Europe based on the values of protocol 26 (TEU and TFEU). Symposium organised by the European Confederation of Independent Trade Unions. Held Warsaw, Poland, October 11th, 2012.

Fulop N. (2012). Doing research that matters to health care managers: issues and challenges. Karolinska Institutet Medical Management Centre 10th Anniversary Seminar, ‘Translational research, knowledge translation and implementation science – an opportunity for healthcare’, Nobel Forum, Wallenbergsalen, Karolinska Institutet, Stockholm, 29th – 30th May.

Robert, G. (2012). Creating high performing health care organizations. Panel session. Canadian Association for Health Services and Policy Research Annual Meeting. Held May 2012, Montreal, Quebec.

Fulop, N. (2012). Organisational and social perspectives on patient safety and quality in healthcare: Contributions, critiques, and future directions. Keynote address, 2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare. Held 6th-7th March, 2012, Copenhagen.

2011

Fulop N. (2011). Organisational and social perspectives on patient safety: contributions, critiques and future directions. Making Health Care Safer: Learning from social and organisational research, St Andrew’s University, 27th - 28th June.

Other conference presentations

2013

Anderson, J., and the QUASER Team (2013). Organisational and cultural factors influencing the implementation of quality improvement. Presented at the Florence Nightingale School of Nursing and Midwifery Research Conference. Held 4th – 5th July, King’s College London.

Anderson J., Robert, G., Fulop, N., Burnett, S., Bal, R., Aase, K., Andersson-Gare, B., Nunes, F., and the QUASER team. (2013). Quality & Safety in European hospitals (QUASER): A guide for senior leadership teams to help improve and sustain hospital quality. Presented at the European Health Management Association Conference. Held 26th-28th June, Milan, Italy.

Charles, K., Burnett, S., Robert, G., Anderson, J.E., Poestges, H., Fulop, N., Bal, R., Aase, K., Nunes, F., Andersson-Gare, B., and the QUASER team. (2013).How do hospital leaders balance external and internal demands in delivering quality improvement? Presented at the Health Services Research Network Symposium. Held 17th-18th June, Nottingham, UK

Fulop N et al. (2013). Approaches to quality improvement in hospitals in five European countries: the QUASER study. Presented at the Health Services Research Network Symposium. Held 17th-18th June, Nottingham, UK

Charles, K., Burnett, S., Robert, G., Anderson, J., Poestges, H., Fulop, N., Bal, R., Aase, K., Nunes, F., Andersson Gäre, B. and the QUASER team. (2013). Quality and Safety in European Union Hospitals. A research-based guide for implementing best practice and a framework for assessing performance (QUASER). Poster presented at the International Forum on Quality and Safety in Healthcare. Held 16th-19th April, London, UK.

von Plessen, C., Espe, A.M., Harthug, S., Wiig, S., and the QUASER Team. (2013). Sustainable quality improvement as a result of interactions on micro-meso-macro levels. Poster presented at the International Forum on Quality and Safety in Healthcare. Held 16th-19th April, London, UK.

Wiig, S., Aase, K., von Plessen, C., Burnett, S., Weggelaar, A.M., Nunes, F., Andersson-Gare, B., Calltorp, J., Fulop, N., & the QUASER team. (2013). Conceptualization of quality across Europe. Poster presented at the International Forum on Quality and Safety in Healthcare. Held 16th-19th April, London, UK.

2012

Karltun, A., & Lahger A. (2012) Developing a sustainable infection control program in health care. The 6th NOVO symposium on Sustainable Health Care: Continuous Improvement of Processes and Systems, Held November, 25th-26th, Karolinska Institutet, Stockholm.

Wiig, S., von Plessen, C., Aase, K., & QUASER team. (2012). Resilient features of clinical micro systems – a case study of Norwegian maternity services. Presented at the European workshop on risk management for patient safety. Held 21st November, in Brussels. Organised by DNV.

Sanne, J. (2012). Sustainable quality improvement requires a multidimensional approach. Presented at the NOVO symposium. Sustainable Health Care: Continuous Improvement of Processes and System. Held 15-16 November 2012, Karolinska Institute, Stockholm.

Gjestsen, M. Aase, K., & QUASER team. (2012). “Preach and practice” – Patient experiences in QI work within a hospital’s maternity services. Presented at the European workshop on risk management for patient safety. Held 21st November, in Brussels. Organised by DNV.

Burnett S, Poestges H, Charles K, Anderson J, Robert G, Fulop N and the QUASER team (2012). Quality & Safety in Europe by Research (QUASER): a comparative, multi-level study of the system and organisational interactions that shape quality improvement implementation in five European countries. Presented at the European Public Health Conference held in Malta, 8-10 November, 2012. European Journal of Public Health, 22(suppl.2): 113.

Bal, R., Quartz, J., Hörbst, V., Poestges, Robert, G., & Sanne, J. (2012). Successful translation in hospital quality improvement: Enactment, risk objects and improvement scripts. Presented at the Annual Meeting of the Society for Social Studies of Science (4S). Held in Copenhagen, October 17-20th.

Fulop, N. (2012). Studying quality and safety in European hospitals – QUASER: Understanding organisational and cultural factors influencing the implementation of QI systems. Presented at International Forum on Quality and Safety In Healthcare, Paris, 19th April, 2012.

Wiig, S., Aase, K., & the QUASER team. (2012). A joyous occasion? How centralisation as part of quality improvement shapes power battles within organising of maternity care. Proceedings of the 2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare. Held 6th-7th March, 2012, Copenhagen.

2011

Wiig, S., Quartz, J., von Plessen, C., & Harthug, S. (2011). Organizing for quality and safety in health care - the Norwegian case. Presented at the European Safety and Reliability (ESREL) conference, 18th-22nd September 2011, Troyes, France. In Bérenguer, Grall & Guedes Soares (Eds). (2012). Advances in Safety, Reliability and Risk Management. Taylor & Francis Group, London.

Wiig, S., Harthug, S., von Plessen, C., & Burnett, S. (2011). Measuring quality and safety in Norwegian health care - time for a change? Presented at Healthcare Systems and Ergonomics and Patient Safety, June 22-24, Oviedo Spain. In Albolino, S., Bagnare, S., Bellandi, T., Llaneza, J., Rosal, G., & Tartaglia, R. (eds.) (2011). Healthcare Systems Ergonomics and Patient Safety 2011 – an alliance between professionals and citizens for patient safety and quality of life. CRC Press, Taylor& Francis Group, London, UK.

Gomes, S., Fernandes, A., Martins, L., & Nunes, F. (2011). Quality management in hospitals: Logic of adoption and implementation of QI programmes. Presented at the Fórum Excelência, held 27th-29th June, Lisbon, Portugal.

Gomes, S., Fernandes, A., Martins, L., & Nunes, F. (2011). QUASER Project: Quality and Safety in European Union Hospitals. Presented at the Fórum Excelência, held 27th-29th June in Lisbon, Portugal.

Fulop, N. (2011). The road less travelled: The story of an FP7 project – Studying Quality and Safety in European Hospitals (QUASER). Presented at the Service Delivery and Organisation (SDO) Network and Health Services Research (HSR) Network’s fourth joint annual conference, held 7th -8th June in Liverpool, UK.

Gomes, S. (2011). The QUASER project. Poster presented at the First International Meeting on Quality and Patient Safety, held 27th-28th May, in Lisbon, Portugal.

2010

Weggelaar, A. (2010). Learn to improve, improved learning. Presented at the Academy of Management, Division of Health Care Management workshop, held August 7th, 2010 in Montreal, Canada.

Workshops:-

Groene, O., Fulop, N., & Sunol, R. (2012). Research into the effectiveness of European quality improvement systems: Approaches, evidence and current issues. BMJ Forum for Quality and Safety in Health Care, Paris, April, 2012.

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QUASER has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241724.

Page last modified on 28 mar 14 15:27