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National quality improvement policies and strategies in European healthcare systems
  1. E Spencer,
  2. K Walshe
  1. Herbert Simon Institute for Public Policy and Management, Manchester Business School, Manchester, UK
  1. Professor K Walshe, Harold Hankins Building, Manchester Business School, Booth Street West, Manchester M15 6PB, UK; kieran.walshe{at}


Objective: This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact.

Study design: A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project.

Participants: The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems.

Principal findings: There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement.

Conclusions: Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.

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  • Funding: This work was funded by the European Commission within the Sixth Framework Programme (contract no 513712).

  • Competing interests: None.

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