National quality improvement policies and strategies in European healthcare systems

Professional involvement, training, and initiatives (16 member states)

Under-funding (17 member states)

A legal requirement to implement QI (15 member states)

Lack of political leadership and strategic planning (15 member states)

Public demand, expectations and involvement (12 member states)

Lack of incentives, confused incentives, low motivation (12 member states)

Quality improvement projects, eg, accreditation, licensing, awards, quality assurance, circles and forums, quality committees, improvement centres (10 member states)

Cultural barriers, eg, professional or bureaucratic (11 member states)

Political interest (9 member states)

Lack of professional training or education (10 member states)

Harmonisation of policy across the EU, progress in other member states, international guidelines (7 member states)

Under-staffing, time issues, neglect of staff interests (10 member states)

A national strategy for QI (7 member states)

Inadequate management and governance structures (9 member states)

A national society for quality (6 member states)

Lack of clarity in standards, accountability, controls, and priorities (5 member states)

Financial incentives to implement QI (6 member states)

Weak public pressure (5 member states)

Strong leadership (5 member states)

Punitive and negative approaches to monitoring quality or errors (5 member states)

Data on clinical performance (5 member states)

Lack of coordination; networking at organisational, local, and regional levels (5 member states)

Having clear and explicit QI policies (4 member states)

Political change and transition (4 member states)

Lack of and fear of transparency (4 member states)

Inadequate or uncoordinated data on quality (4 member states)