Qual Saf Health Care 18:i28-i37 doi:10.1136/qshc.2008.029363
  • Supplement

Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project

Open Access
  1. M J M H Lombarts1,
  2. I Rupp1,
  3. P Vallejo2,
  4. R Suñol2,
  5. N S Klazinga1
  1. 1
    Academic Medical Center, Department of Social Medicine, University of Amsterdam, Amsterdam, the Netherlands
  2. 2
    Avedis Donabedian Institute, Autonomous University of Barcelona, and CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  1. Dr M J M H (Kiki) Lombarts, Academic Medical Center, Department of Social Medicine, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, the Netherlands; m.j.lombarts{at}
  • Accepted 12 November 2008


Context: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients.

Aim: This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients’ views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment.

Methods: A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006.

Results: 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies.

Conclusions: Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.


  • Funding: Research done for the “Methods of Assessing Response to Quality Improvement Strategies (MARQuIS)” project (SP21-CT-2004-513712) was funded by the European Commission through its Scientific Support to Policies action under the Sixth Framework Programme for Research.

  • Competing interests: None declared.