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International Journal for Quality in Health Care Advance Access originally published online on August 18, 2009
International Journal for Quality in Health Care 2009 21(5):330-340; doi:10.1093/intqhc/mzp031
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© The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Longitudinal analysis on the development of hospital quality management systems in the Netherlands

Michel Dückers1, Peter Makai2, Leti Vos1, Peter Groenewegen1 and Cordula Wagner1

1 NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
2 Institute of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands

Objective. Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals.

Design. Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage.

Setting. Dutch hospital sector between 1995 and 2007.

Participants. Hospital organizations.

Intervention. Changes through time.

Main Outcome Measure. Quality management system development stage.

Results. Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size.

Conclusions. Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.

Keywords: quality management, hospitals, country report, organization of health care

Address reprint requests to: Michel Dückers, NIVEL—Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands. Tel: +31-302729603; Fax: +31-302729729; E-mail: m.l.duckers{at}amc.uva.nl

Accepted for publication July 16, 2009.


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