London School of Hygiene & Tropical Medicine

The findings, published in a series of 12 papers in the International Journal of Quality in Health Care, also state that many European hospitals lack patient-centred care.

The DUQuE project (Deepening our understanding of quality improvement in Europe) was financed by the European Commission and started in November 2009. Over a 42-month period, the collaboration collected data from 188 hospitals across eight countries including the UK, Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. This included surveys of over 9,800 professionals and 6,500 patients, and reviews of more than 9,000 patient charts, making it the largest collaborative project ever to investigate the effect of quality management systems in European hospitals.

Lead author Dr Oliver Groene, Lecturer in Health Services Research at the London School of Hygiene & Tropical Medicine, said: "We see persistent variations in quality and safety of healthcare in hospitals, and it's becoming increasingly important to know what hospitals are doing to ensure care delivery is as high quality and homogenous as possible. The NHS can learn a lot from experiences in European countries. The results from our detailed study could help inform the use of a large number of interventions which are available to improve the quality of care."

The study found that there was a concerning level of non-compliance with key quality requirements. For example, only one in three wards had removed potassium chloride concentrate solution (known to be fatal if given inappropriately) from their general stocks, even though this practice was recommended by the UK National Patient Safety Agency as early as 2002. It was also found that only 56% of clinical areas had arrangements in place to treat heart attacks within the recommended timeframe. And only half of all medical and surgical wards met the standard to identify more than 90% of their patients by a wristband. The authors say these figures are far below the compliance rates that are usually expected for such basic and crucial safety recommendations.

Another key concern highlighted by the study was a lack of patient-centred care. The researchers found that while quality management systems were able to ensure effectiveness and safety, they had no effect on patients' perceived experience of care. The study found that there were low levels of patient involvement in quality management functions, including patient participation in quality committees, patient surveys or involvement in developing care pathways, showing that this was a neglected area within quality management.

While it was recognised that high-level quality management systems were required to solve hospital-wide issues, for example, hospital infections and rescue after high-risk surgery, the study also showed that high level quality management without clinical involvement had little impact on the quality of care.

Publication

• Mariona Secanell, Oliver Groene, Onyebuchi A. Arah, Maria Andrée Lopez, Basia Kutryba, Holger Pfaff, Niek Klazinga, Cordula Wagner, Solvejg Kristensen, Paul Daniel Bartels, Pascal Garel, Charles Bruneau, Ana Escoval, Margarida França, Nuria Mora, Rosa SuÑol, and on behalf of the DUQuE Project Consortium. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care. DOI: 10.1093/intqhc/mzu025