Table 6 Factors identified by respondents as facilitators or barriers to the progress of healthcare quality improvement (QI)
FacilitatorsBarriers
  • 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)