Applying the Model of the European Foundation for Quality Management to evaluate quality of care alongside the merger of mental health care institutes in Amsterdam: a five year pre–post study

Abstract Background Health care reforms over the past decades in the Netherlands enforced institutions to enhance quality and to contain costs. To cope with the policy context, a majority of mental health care institutes applied a merger strategy and hence large mental health care organizations were created. This study assesses the impact of a merger and the related quality management approach on the quality of care of three large Dutch mental health care institutes in Amsterdam. The nine criteria of the Model of the European Foundation for Quality Management (EFQM Model) with 32 criteria parts for total quality management were used. Method A case study with a pre–post design was applied, with the EFQM baseline (pre) and follow-up (post) assessments using the standardized EFQM protocol with a 0%–100% scoring system. The baseline status of 2007–2008 was scored and validated by seven independent certified assessors. During a period of 5 years, the merge was conducted, enhancing the quality management and effectuating the findings of the advice of the feedback report. An EFQM post-assessment of the status of 2012–2013 was carried out by five independent certified assessors applying the strict EFQM assessment protocol. The statistics of pre–post differences were evaluated. The study can be seen as a before–after assessment of a naturalistic experiment. Results The comparison of the nine EFQM criteria before and after the merger on the bases of the scores of the assessors shows an overall improvement from 358 to 425 points on the EFQM scale 0–1000. There is one slight deterioration concerning criterion 8: Society Results, five criteria show positive changes. The top three criteria with the highest improvement are 1: Leadership (15% improvement), 5: Processes, Products, and Services (12%), 6: Customer Results (15%). The overall statement of the audit team of 2013 is ‘The merged organisation strives for effectiveness, which leads to better results in most of the areas.’ Learning from the results is one recommendation of the assessors for the future. Conclusion The conduced merge of three Dutch mental health care institutions in Amsterdam showed an improvement of quality based on the criteria of the EFQM Model over a period of 5 years. This naturalistic experiment can stimulate further studies about mergers. The systematic and transparent approach and documentation can facilitate mutual learning.