The Flanders Quality Model, FlaQuM, is a new quality model that should support hospitals in their quest for a sustainable quality policy. This model consists of a vision model and a cocreation model and was designed in a multi-method way. Currently, it is being implemented in 23 living lab hospitals.

Why are we developing new models?

Since the publication of the To Err is Human report, quality has been a strategic objective for many care organisations. In Flanders, too, quality policy has been the subject of hard work in recent years. The Flemish government introduced the quality triad some ten years ago, in close consultation with Flemish hospitals. This triad indicates that hospitals and the government work on a) public reporting, b) inspection by the Flemish government and c) hospitals initiated an accreditation policy. Public reporting is done via www.zorgkwaliteit.be, the Care Inspectorate checks whether hospitals meet the predefined requirements and the hospitals have themselves accredited by an external company.
In 2022 hospitals have undergone several inspections and several indicators are reported publicly. These are both indicators about general hospital policy and pathology-specific indicators. Almost all Flemish general hospitals have now completed an initial accreditation process and several psychiatric and rehabilitation hospitals have also passed this test.
Although participation in this triad has certainly made a significant contribution (please read Van Wilder et al, 2021), many hospitals feel that it is time to take up the next challenge. Several hospitals are stopping the accreditation process and the Flemish government decided in December 2021 to critically examine the triad as well. With the support of Zorgnet Icuro, the Flemish umbrella organisation for hospitals, the Leuven Institute for Health Care Policy was given the opportunity to work out new models to support general, psychiatric and rehabilitation hospitals in their future quality policy.

A vision & cocreation model

A vision model was developed within this research. The vision model helps hospitals to jointly choose the direction they are going in and to examine how this fits in with their strategy, values and standards. This takes into account the internal client (the employee/care provider) as well as the external client (the patient and his/her relatives). Read more in Lachman et al, 2021.

As previously described in the literature, we use this multidimensional model as the next step in the history of quality (read Vanhaecht et al, 2021). The vision model consists of two overarching dimensions (attention for the person (patient and staff) and attention for their relatives). On the other hand, five of the six technical dimensions of quality described in Crossing The Quality Chasm remain. These are safety, effectiveness, efficiency, timeliness and equality. The original person-centredness dimension becomes an overarching dimension and sustainability/eco-friendlyness is initiated as a new sixth technical dimension. To connect the six technical dimensions and the overarching dimensions, three catalysts are defined: transparency, leadership and resilience. Finally, the multidimensional model includes four core dimensions or values for good care. These core dimensions or basic values of good care must always be applied in every contact between healthcare providers and patients or relatives, but also in contacts between staff members. These four core values are: dignity and respect, holistic vision, partnership and co-production, and finally empathy and kindness. The findings from the Lachman model were discussed during interviews and focus groups with quality assurance staff, management, healthcare providers and patients and relatives (read Claessens et al, 2022 in press). Based on the information from this multimethod approach, a survey instrument was also developed, known as the FlaQuM Quickscan, which enables hospitals to question their stakeholders about the various dimensions of the multidimensional model.

In addition, a co-creation model was developed. The co-creation model helps hospitals to create and secure the quality policy in their own organisation or together with partner organisations via multiple drivers, building blocks and fields of action, via self-evaluation & projects. In this manuscript, we briefly explain the content and history of both models.

However, having an idea of how stakeholders view quality is obviously not enough to be able to convert this vision into an actual quality policy. Therefore, in addition to the previously described vision model, a co-creation model was also developed. This co-creation model is a management model that helps hospitals to develop, implement and monitor their quality vision step by step. The model is based on a thorough literature study, interviews with quality staff and international quality experts. The co-creation model was developed as a driver diagram consisting of six primary pillars and 19 secondary pillars. The six primary pillars are: quality design, quality monitoring, quality improvement, quality leadership, quality culture and quality context. These primary pillars are further described in 19 building blocks and a total of 104 fields of action (read Claessens et al, 2022 in PLOS ONE in press). This model with 6 pillars, 19 building blocks and 104 fields of action helps a healthcare organisation to implement quality step by step and to secure it permanently within the organisation. It is the roadmap that hospitals can follow for this and also attune to their own experience, expertise, context, needs and wishes.

What is happening now?

The FlaQuM vision model and the FlaQuM co-creation model together form the basis of the FlaQuM quality management system. This quality management system has in the meantime inspired a number of Flemish hospitals. These hospitals are now participating in the FlaQuM living lab. This trial garden consists of 18 general hospitals, three university hospitals (two general and one psychiatric) and two rehabilitation hospitals. These 23 hospitals are currently working on a new internal quality management system within their own organisation. They have decided not to continue with the well-known hospital accreditation but to put their resources and energy into developing the internal FlaQuM model. They work with the vision model, use the FlaQuM quickscan and the FlaQuM cocreation model is the roadmap that helps them pillar by pillar, building block by building block and action field by action field towards a sustainable quality policy. Besides the internal project to further develop their own quality, staff members, board members and clinicians participate in various work groups in which experts from the 23 hospitals think together to further design the FlaQuM model. Through these FlaQuM workgroups, the vision model, including the quick scan and the cocracy model will be further developed into FlaQuM 2.0. This FlaQuM 2.0 system should be operational within about two years, so that the hospitals are ready for an external assessment as the Flemish minister is currently developing.

Some first conclusions

The positive experiences and evolution of the Flemish quality policy in recent years have ensured a sound quality policy. Several Flemish hospitals want to raise the bar even higher and strive for a quality policy that is permanently anchored in the organisation’s genes. That is why they are now working closely together within their organisations with all the stakeholders involved and between the organisations in FlaQuM working groups that are working via codesign on a FlaQuM 2.0 system. The hospitals will critically reflect on the steps made and will also continue to report externally, so that they can continue to inspire other hospitals that have not yet decided to participate in this living lab and share their knowledge.

MORE INFORMATION: Contact our FlaQuM project manager Charlotte Van der Auwera