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A quality management system (QMS) is defined as interacting activities, methods and procedures used to monitor, control and improve service quality. The purpose of this paper is to describe the QMS status using the Quality Management System Index (QMSI) in hospitals affiliated to Shahid Beheshti Medical Sciences University in Tehran, Iran.

In this cross-sectional study, 28 hospitals were investigated. A validated 46-item questionnaire was used for data collection. Data were analyzed using descriptive statistics, Pearson correlation, independent student’s t-test and regression analysis.

The mean QMSI score was 18.4: 15.3 for public and 20.9 for non-public hospitals (p=0.001). The lowest (1.96) and the highest (2.14) scores related to “Quality policy documents” and “Quality monitoring by the board,” respectively. The difference between public and non-public hospitals was significant in all nine QMSI dimensions (p=0.001). The QMSI score was higher in non-public and small hospitals than in public and large ones (p=0.05).

Most QMS studies come from developed countries, and there is no systematic information about the mechanisms and processes involved in implementing QMS in developing countries like Iran. This is the first study on Iranian hospital QMS using a newly developed tool (QMSI), and results showed that QMS maturity in these hospitals was relatively good, but the non-public hospitals status (private and charity) was far better than public hospitals.

To deepen our insight into the Dutch system of visitatie, a doctors‐led and ‐owned external peer review mechanism through site visits, a process evaluation was performed. The study focussed on the practice‐specific recommendations for improvement as the measurable outcome of the peer review process, the attitude of medical specialists towards visitatie, and towards the recommendations. Medical specialists’ positive attitudes towards visitatie hold promise for the implementation of the recommendations for improvement, an essential final step in the process. In order to achieve improvements tailor made implementation strategies need to be offered. Specialty societies and hospital managers could play a role in facilitating improvement.

Three years after a consensus development conference on blood transfusion policy in the Netherlands, its effect on the quality of care was evaluated. In 16 out of 22 bloodbanks and 66 per cent of the hospitals the consensus text had been discussed and used as a basis for the formulation or modification of guidelines. In 17 (nine per cent) hospitals a formal quality assurance study had been performed: In 11 change was found to be necessary; a re‐evaluation, performed in seven, showed improvement of transformation policy in five. In all studies the criteria used were in agreement with the statements of the consensus text.

The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by “walking the safety talk” (enacted priority of safety).

Open interviews (N=26) and a cross-sectional questionnaire (N=183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands.

As hypothesized, leaders’ enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders’ enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders’ role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions.

We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings.

Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial.

Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.

The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.

A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.

The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.

The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.

This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

The purpose of this paper is to study the quality indicator appropriateness and use it for international quality comparison on diabetic retinopathy (DR) patient care process in one American and one Dutch eye hospital.

A 17-item DR quality indicator set was composed based on a literature review and systematically applied in two hospitals. Qualitative analysis entailed document study and 12 semi-structured face-to-face interviews with ophthalmologists, managers, and board members of the two hospitals.

While the medical-clinical approach to DR treatment in both hospitals was similar, differences were found in quality of care perception and operationalization. Neither hospital systematically used outcome indicators for DR care. On the process level, the authors found larger differences. Similarities and differences were found in the structure of both hospitals. The hospitals’ particular contexts influenced the interpretation and use of quality indicators.

Although quality indicators and quality comparison between hospitals are increasingly used in international settings, important local differences influence their application. Context should be taken into account. Since that context is locally bound and directly linked to hospital setting, caution should be used interpreting the results of quality comparison studies.

International quality comparison is increasingly suggested as a useful way to improve healthcare. Little is known, however, about the appropriateness and use of quality indicators in local hospital care practices.

To explore theoretically the reasons for the modest uptake of clinical governance practices by taking the literature on the origin of tensions between doctors and managers as the starting‐point.

The approaches of doctors and managers to the division and coordination of medical work are analysed theoretically from a twofold perspective that combines insights from sociologists' theories on “professionalism” and administrative scientists' theories on “management science”.

The combined perspective theoretically explains the problems between doctors and managers that frustrate the uptake of clinical governance practices. By inference from this theoretical analysis, a twofold agenda for a constructive dialogue is proposed. Doctors and managers must develop a shared vision of the division and coordination of medical work as well as discussing the values, norms and goals underlying patient care. It is questionable, however, whether this agenda is currently adequately addressed.

This paper provides a theoretical underpinning for the dialogue between doctors and managers. It may be enlightening for all doctors and managers working in the field.

The paper aims to investigate the quality in health care with regard to the blood transfusion policy in Dutch hospitals.

The value of an approach to good standards of health care practice, based on Consensus Development Conferences is analysed in the paper in the context of blood transfusion policies.

The paper finds that the Consensus Development Conference on transfusion policy had a substantial impact on daily practice of care in Dutch hospitals.

The paper provides useful information on maintenance of good health care standard with regard to blood transfusions in Dutch hospitals.

The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program’s content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture.

Pre- and post-assessments of the hospitals’ safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice.

The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction.

The study was observational and the hospital’s variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention.

Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on “team” instead of “profession” seems both necessary and difficult in hospital care.