Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

Retaining formal volunteers in volunteer based organizations

Abstract Problem Formal Volunteers in volunteer based organizations drop out at a fast pace due to many reasons like lack of interest what they are doing, conflict among volunteers, lack of motivation, job dissatisfaction due to prolonged volunteering etc.  which is causing to improper functioning of these organizations and reaches a point where these volunteer based organizations find it difficult to function properly. The author in this study tries to address this particular issue of this drop out of formal volunteers. Purpose The purpose of this study is to explore the factors which helps in the retention of formal volunteers in a volunteer based organization for a longer period. Method The research in this paper is done in a qualitative way with primary data collected in the form of participant observation and open interview in two voluntary organizations. The collected data is analyzed in content analysis. The secondary data is collected in the form of necessary documents provided by the participating organizations. Results Many factors were found to influence retention of volunteers namely Job satisfaction, Motivation, Public Service Motivation, Organizational Commitment, Mission Attachment, Work load, Relationship with Coworkers, Justice of Organization, Flexible Timing, Training & Orientation.  Conclusions Recommendations to improve retention is mentioned and a future model is also proposed. The result obtained from this research can be generalized to other form of small scale volunteer organizations where the major employees are formal volunteers.