Abstract
Background: The quality policy for hospitals enrolled in 2009 by the Flemish government, is based on a ‘Quality-of-Care Triad’ consisting of accreditation, inspection and public reporting of quality indicators. Since 2021, an accreditation label no longer replaces governmental quality system inspection in Flanders. Today, hospitals have the opportunity to build their own quality management system, but questions are raised on the development of a sustainable one. To address this gap in existing research, we aimed to develop a conceptual model towards sustainable, integrated quality management and to implement this model in healthcare organisations.
Methods: A multi-methods approach in co-design with 19 healthcare organisations is used to develop a conceptual model. Development phases based on literature and multistakeholder feedback are followed by implementation phases in a convenience sample of 19 organisations (living labs) and by validation of the models based on their recommendations.
Results: Flanders Quality Model (FlaQuM) towards sustainable, integrated quality of care constitutes 1) a vision model, 2) a co-creation roadmap and 3) a learning consortium of livings labs. For the vision model, a validated measurement tool, the FlaQuM Quickscan, was developed to measure quality experiences from a multistakeholder perspective (patients and kin, professionals and primary care) and ensures that organisation’s quality vision is rethought from an integrated, multidimensional approach. The co-creation roadmap guides organisations to build their quality management system by focusing on six drivers and 19 buildings blocks. Organisation’s maturity in those drivers and building blocks can be mapped using two tools: the FlaQuM Maturity matrix and FlaQuM Co-creation scan. Those are developed in co-design by conducting 20 focus groups with 79 content experts. Every 18 months, the FlaQuM Quickscan, FlaQuM Maturity matrix and FlaQuM Co-creation scan will be disseminated in the living labs and results will be fed back in benchmarking reports. During learning sessions with the consortium of 19 living labs, consisting of coordinators and board members from each organisation, results of tools are discussed and recommendations are used to further validate FlaQuM. The consortium is based on the learning principles of the Breakthrough Improvement Collaborative.
Conclusion: FlaQuM is a new, unique model towards sustainable, integrated quality management that includes a vision model, co-creation roadmap and a learning consortium of living labs. By focusing on building a shared quality vision pursued through co-creation with all healthcare stakeholders, the organisation’s desired maturity level can be reached.
Practice implications: FlaQuM and the developed tools can guide researchers, policymakers, healthcare managers and clinicians to build a sustainable quality management system while focusing on commitment, ownership and engagement of healthcare stakeholders to quality.
Next steps: Future research will focus on the evaluation of the implementation of FlaQuM in the living labs. The realistic evaluation model to explore the context (C) in which FlaQuM is implemented, to understand the mechanisms (M) of change and the define impact on certain outcomes (O), will support to understand if, how and why FlaQuM works. Studying barriers and facilitators to implement FlaQuM in living labs, will help to disseminate FlaQuM in various healthcare settings.