Thinking

Why are we developing new models?

In Flanders, the northern region of Belgium with more than 6.5 million inhabitants and around 70 acute-care and specialised hospitals, a governmental coalition agreement was established in 2009. In this agreement between the government and hospital associations a ‘Quality-of-Care Triad’ was defined and hospitals were encouraged to build their quality management system mainly around this triad. The latter consists of a voluntary organisation-wide external accreditation by an international external agency, mandatory governmental inspections and voluntary public reporting of quality indicators. The mandatory governmental inspections consist of an announced systemic inspection of which accredited hospitals are exempt, as well as a yearly unannounced examination of patient trajectories. As described in a recent study, Flemish hospitals have been increasingly implementing the Flemish ‘Quality-of-Care Triad’, especially from 2020 onwards, with 100% of Flemish hospitals having obtained an accreditation label by either the JCI or the Dutch Qualicor Europe; and all hospitals voluntarily publicly reporting a selected set of quality indicators.

After a decade of commitment to this ‘Quality-of-Care Triad’, there was a need to evaluate and rethink this Flemish quality policy. Consequently, the Flemish minister of healthcare stated in 2021 that no governmental inspections on hospitals’ quality management system would be conducted before December 2023. In practice, each hospital is given the opportunity to design their own quality management system but they still have to comply with the generic standards and disease specific standards controlled by Flemish government and other laws on healthcare, quality and patient safety in Flanders, Belgium and Europe. So, 22 Flemish hospitals combined their experience and expertise in developing a quality management system and participate in the FlaQuM-Consortium.

Multidimensional model

The multidimensional quality vision model supports hospitals to co-define their future quality direction and to examine how this future direction fits with their strategy, values and standards. This model extends the meaning of person-centeredness by focusing on the hospital’s internal clients (the employee/healthcare provider) as well as on its external clients (the patient and his/her relatives or ‘kin’). Read more in Lachman et al, 2021 and Claessens et al, 2022.

As previously described in the literature, we use this multidimensional model as the next step in the history of quality (Vanhaecht et al, 2021). The vision model consists of two overarching dimensions (person-centeredness (patients and healthcare professionals) and kin-centeredness). On the other hand, five of the six technical quality dimensions, as described in Crossing the Quality Chasm, remain. These are safety, effectiveness, efficiency, timeliness and equality. The original person-centeredness dimension becomes an overarching dimension and sustainability/eco-friendliness is initiated as a new sixth technical dimension. To connect the six technical dimensions and the overarching dimensions, three catalysts are defined: transparency, communication, 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 during both the interaction between healthcare providers and patients or kin/relatives as well as during the interaction between healthcare providers. These four core values are: dignity and respect, holistic care, partnership and co-production, and finally kindness with compassion.

To measure this quality vision model from an integrated, multistakeholder perspective, the FlaQuM Research Team developed and validated an instrument, the FlaQuM-Quickscan. The FlaQuM-Quickscan is a two-part instrument that measures ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). Each instrument part includes a series of statements, i.e. one statement for each quality domain of the quality vision model, and three global ratings. Patients, kin, in-hospital healthcare professionals and primary care professionals complete both instrument parts. Based on a multi-center study of 19 hospitals and a sample of 14,165 respondents (5,891 patients/kin, 7,724 in-hospital healthcare professionals and 550 primary care professionals), our research team published the validation results in an international journal. Next, how the results of the FlaQuM-Quickscan can be used to set priorities on meso (organisational) and macro (national) levels is demonstrated in a recent publication in NEJM Catalyst.

Besides the results of healthcare quality experiences, FlaQuM also focuses the measurement of hard patient outcomes. Each hospital of the FlaQuM-Consortium receives a feedback report of the ‘vital few’ patient outcomes (in-hospital mortality, 30-day readmissions and length of stay) and a set of evidence based patient safety indicators (PSI). These PSIs are based on AHRQ indicators and validated for the Flemish context. Longitudinal follow-up and benchmarking of patient outcomes is the starting point towards targeted quality improvement interventions.