Understanding Variation in Health Care Quality Experiences of Three Stakeholders: Patients and Kin, Professionals, and Hospitals

SummaryAs quality of care increasingly becomes a strategic topic for hospitals, understanding variation between stakeholders’ experiences is essential. A framework can be used by managers, researchers, and policy makers to account for these variations and set priorities to ensure an environment of trust among all stakeholders — including patients and kin. To measure perceptions of quality from a multidimensional view, researchers at the Leuven Institute for Healthcare Policy established four objectives. The first was to explore whether patients and kin (collectively), and professionals experience quality as a multidimensional concept. The second was to examine the between-stakeholder variation across health care quality experiences of patients/kin and professionals. The third was to examine between-hospital variation in health care quality experiences among the 19 hospitals studied. The fourth was to set quality priorities for hospital management and policy makers based on multistakeholder and multicenter data. To collect information, researchers used the Flanders Quality Model (FlaQuM)-Quickscan tool, which is a two-part instrument that measures quality from a multidimensional view. It includes a series of statements on health care quality for patients and kin (part 1) and a corresponding series of statements on health care quality for professionals (part 2), each consisting of 15 quality domains and three global ratings; all respondents were required to address both parts 1 and 2. To explore whether quality is experienced as a multidimensional concept, intraindividual variation was examined by analyzing stakeholders’ differences between minimum and maximum scores on the instrument domains. Between-stakeholder variation was examined by evaluating differences in mean scores of the two stakeholder groups on the quality domains using unpaired t-tests. Between-hospital variation was examined by evaluating differences in hospitals’ mean scores on the quality domains using one-way analysis of variance (ANOVA). In total, 14,977 respondents (6,590 patients/kin and 8,387 professionals) completed the FlaQuM-Quickscan during the study period between May 2021 and June 2022. Respondents used a Likert scale, where 0 is full disagreement with the statement and 10 is full agreement. Analyses revealed important intraindividual variation in experiences of respondents across quality domains. Researchers also observed that patients/kin scored all domains (in parts 1 and 2) significantly higher than professionals, except for the Equity domain in part 2. Significant between-hospital variation in the mean scores was observed for all domains. Of note, by combining the correlation of the overall quality scores with the quality domains, the difference in mean scores on domains, and the variation between hospitals’ mean scores, priorities can be identified. Overall, researchers found that patients/kin and professionals do experience quality as a multidimensional concept. The multidimensional priorities identified based on the FlaQuM-Quickscan results indicate the need for future multifaceted quality strategies at the meso and macro levels that can have an impact at the patient care level. Hospital management and policy makers need to support the integration between executive/management-level and frontline-level initiatives.