An explorative qualitative research about how healthcare professionals and managers perceive that a quality system based on narrative measurements affects their internal responsibility.

Abstract

Background – The current quality systems aimed at external justification do not appear to be effective in improving the quality of care. Healthcare professionals (HCP) and healthcare managers (HCM) are critical about the quality systems. Therefore, the aim of this study is to explore the perspectives of HCP and HCM at a quality system aimed to improve internal responsibility (PREZO Care audit) through improving reflective, normative professionality and quality awareness. Besides, the research looks at different motivators that might influence the development of reflective, normative professionality and quality awareness.

Method – The data were collected from 17 semi-structured interviews in April and May 2019 from three organizations that completed the PREZO Care audit pilot between September 2018 and May 2019. From these interviews 10 participants were classified as an HCP and 7 were classified as HCM.

Results – In general, participants experienced that the PREZO Care audit ensured a reinforcement and/or increase and/or confirmation of normative professionality, reflective professionality and quality awareness. Motivators found in current research are that HCP and HCM perceived that the PREZO Care audit: (1) Was relevant to the healthcare organization; (2) Did justice to the lived reality; (3) Involved all layers of the healthcare organization during the audit. Moreover, the participants experienced support top-down. The motivators ‘support bottom-up’ and ‘reflective culture’ were not found to play a role in how participants perceived that the PREZO Care audit affected internal responsibility.

Conclusion – This research has showed that HCP and HCM perceive that the PREZO Care audit could improve internal responsibility through reflective, normative professionality and quality awareness. Which means that, a different way of justifying quality is needed to improve the quality of care. However, further research is needed to gain a full understanding of narrative quality systems and their effects.