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Table 4 Conceptualizations of quality at the meso level

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

Data source



Emerging themes

Senior manager Norway B

‘Currently we talk about economy, yes, we still talk about that, but not economic aspects only. We talk a lot about professional development, patient quality, patient safety, how to improve patient pathways in an efficient manner, and how to solve the targets specified in the letter of assignment, such as waiting lists, priorities such as deadlines related to discharge summaries. So, when you ask me to compare with other hospitals, I think that all hospitals pay attention to patient safety, because we all know that if our patients and the next of kin are dissatisfied, we have to work against that. That is really tough’.


Economy, measures, professional development

Senior hospital manager Norway B

‘There are too many ruptures. The Minister of Health wants to increase the attention to ruptures to decrease the rate. What we [managers] pay attention to is amplified. That’s how it is, we have to succeed’.


External factor influence, the brokering role of managers in shaping attention to quality

The president of the board Portugal A

‘A place of this size and its multidisciplinary nature should be on another level [treatment] and we should collaborate with clinical trials planned by other hospitals and countries’.


Hospital size and status - CE as being in the forefront of treatment and research

Senior manager England A

‘So demand from the general public and also demand from organisations. Endless streams of targets to try and achieve, which again, they are there for quality, so we have measuring incident rates of thrombosis, pressure sores, all these sorts of things, which is good, and nutrition analysis on the ward, but sometimes these things are … almost the analysis is the means to an end and I think we’re trying to do these things to ensure quality, not just to ensure that we’ve met the targets, and there seems to be a focus on that’.


Measuring quantifiable quality data, response to external demands

Senior manager England A

‘With the recent organizational change, the board intends to replace luck with system, accountability, and assurance’.


Quantifiable quality data

Ward manager Nether-land B

‘I really need a project for it. Yes, now and again I work on it, just to give a subject item a bit of stimulus. But it’s not feasible to do it too often, in addition to all the other things we have to do’.


Quality depend on fragmented external demands

Clinical manager Sweden A.

‘I have been part of the journey that this clinic has done. We have done a long journey regarding process work and development of the clinic and we have come very far and it’s very stimulating to work, everyone is in that thought mode – improvement think’.


Quality culture