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As part of the new Flanders Quality Model (FlaQuM) towards sustainable quality management systems, a co-creation roadmap with 6 primary drivers and 19 building blocks that guides healthcare organizations has been developed. Currently, no assessment tool is available to monitor hospitals' quality management systems implementation according to this co-creation roadmap. Therefore, we aimed to measure the maturity of the implementation of the FlaQuM co-creation roadmap in hospitals. A three-phase approach in co-design with 19 hospitals started with defining the scope, followed by establishing content validity through a literature review, involvement of content experts (n  = 47), 20 focus groups with content experts (n  = 79), and a Delphi round with healthcare quality managers (n  = 19) to test the content validity index. Construct validity was assessed by confirmatory factor analyses and convergent validity by Spearman's ρ correlation coefficients. Based on 17 included existing maturity instruments and subcomponents of content experts, two maturity tools were developed according to the implementation of the FlaQuM co-creation roadmap: (i) a maturity matrix with 52 subcomponents and (ii) a co-creation scan with 19 statements. The overall scale-content validity index varied between 93.3% and 90.0% in terms of relevance and clarity, respectively. In a sample of 119 healthcare professionals, factor analyses revealed a six-factor structure and 16 (84.2%) of the 19 hypothesis for testing convergent validity between both maturity tools were statistically significant. Measuring the implementation of the FlaQuM co-creation roadmap and monitoring its maturity over time should be feasible by using these comprehensive maturity tools in hospitals. Results of both tools should be able to describe the current state of hospitals' implementation of the co-creation roadmap as basis for strategic improvement plans and next steps. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to huge pressure on not only healthcare systems, but also on healthcare professionals. As the pandemic continues, the aim of this study is to evaluate how 10 reactions of healthcare professionals evolved during the first 18 months of COVID-19.Methods: : A repeated cross-sectional study was performed with eight measurement points between April 2020 and September 2021 in Belgium. Participants were asked how frequently (on a scale of 0 to 10) they experienced positive and negative reactions during normal circumstances and during past week, referred to as before and during COVID-19, respectively. These reactions were stress, fatigue, difficulty sleeping, muscle strain, hypervigilance, leaving profession, headache, doubting knowledge and skills, flashbacks and fear.Results: : In total 13 308 respondents were included in our study. During both the first (March 2020) and second COVID-19 peak (November 2020), the measured personal, professional and physical reactions were significantly higher compared to before COVID-19. The third wave in April 2021 was shorter and less severe with regard to hospital admissions and deaths, yet an important impact on healthcare professionals could still be observed. 'Fatigue', 'stress', 'difficulty sleeping' and 'muscle strain' are the most worrying reactions in September 2021, which are increasing compared to the previous measurements.Conclusion: : Our results showed that acute stress reactions decreased over time but that chronic stress reactions and professional reactions such as 'intent to leave', increased. Healthcare organizations and policy makers should realize that 18 months after the start of COVID-19 almost all of the measured reactions continue to be more prevalent than before COVID-19. Moreover, the continuous increase over the last three measurement periods of the number of healthcare professionals who want to leave their profession is alarming. Continuous follow-up of the personal, professional and physical reactions is more than necessary. [ABSTRACT FROM AUTHOR]

Background: Hospital accreditation is a popular and widely used quality control and improvement instrument. Despite potential benefits, ques-tions are raised whether it constitutes appropriate use of hospitals' limited financial resources.Objective: This study aims to calculate the cost of preparing for and undergoing a first and second accreditation by the Joint Commission International or Qualicor Europe in acute-care hospitals.Method: All (n = 53) acute-care hospitals in Flanders (Belgium) were invited to participate and report on the costs in preparing for and undergoing a first and/or second accreditation cycle. To measure costs, a questionnaire with six domains and 90 questions was developed based on literature review, policy documents and a multidisciplinary expert group. All costs were recalculated to 2020 euro to correct for inflation and reported as medians with interquartile range.Results: A total of 25 hospitals (47%) participated in the study. Additional investments and direct operational costs for a first accreditation cycle amounted to 879.45 euro (interquartile range: 794.81) per bed and 3.8 full-time equivalent (FTE) per hospital additional new staff members were recruited for coordination and implementation of the trajectory. A second accreditation survey costed remarkably less with a total cost of extra investments and direct operational cost of 222.88 euro (interquartile range: 244.04) per bed and less investment in additional staff (1.50 FTE). Most of the costs were situated in consulting costs and investments in infrastructure. The median total extra cost (direct operational cost and additional investments) amounted to 0.2% of the hospital's operating income for a first accreditation cycle and 0.05% for a second cycle.Conclusion: A first accreditation cycle requires a strong financial commitment of hospitals, as many costs result from the preparation in the years prior to an accreditation survey. A second survey is less expensive for hospitals, but still requires a considerable effort in terms of budget and staff. Policy makers should be aware of these significant costs as hospitals are operating with public resources and budget is scarce. The identification of these costs is a necessary building block to evaluate cost-effectiveness of accreditation versus other quality improvement systems and the continuation of these accreditation systems and their costs needs further study and a thorough debate. [ABSTRACT FROM AUTHOR]

Background: Anaesthesiologists are prone to patient safety situations after which second victim symptoms can occur. In international literature, a majority of these second victims indicated that they were emotionally affected in the aftermath of a patient safety incident (PSI) and received little institutional support after these events.Objective: To study the current second victim support structures in anaesthesia departments in Belgium.Methods: An observational cross-sectional survey. Belgian anaesthesiologists and anaesthesiologists in training were contacted through e-mail from May 27th until 15 July 2020.Results: In total, 456 participants completed the online survey. 73.7% (n = 336) of the participants encountered a PSI during the last year of their medical practice. 80.9% (n = 368) of respondents answered that they do discuss incidents with their colleagues. 18.0% (n = 82) discussed all incidents. 19.3% (n = 88) admitted that these incidents are never discussed in their department. 15.4% of participants (n = 70) experienced or thought that the culture is negative during these PSI discussions. 17.3% (n = 79) scored the culture neutral. Anaesthesiologists who encountered a PSI in the last years scored the support of their anaesthesia department a mean score of 1.59 (ranging from -10 to +10). A significant correlation (P < 0.05) was found between the culture during the morbidity and mortality meetings, the support after the incidents and the perceived quality of the anaesthesia department.Conclusion: Of the participating anaesthesiologist in Belgium, 80.9% discussed some PSIs and 18.0% discussed all PSIs as a normal part of their staff functioning with an experienced positive or neutral culture during these meetings in 84.6%. Psychological safety within the anaesthesiology departments is globally good; however, it could and should be optimized. This optimization process warrants further investigations in the future. [ABSTRACT FROM AUTHOR]

Background: Since 2009, hospital quality policy in Flanders, Belgium, is built around a quality-of-care triad, which encompasses accreditation, public reporting (PR) and inspection. Policy makers are currently reflecting on the added value of this triad.Methods: We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence base of the impact accreditation, PR and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length of stay, readmissions, patient satisfaction, adverse outcomes, failure to rescue, adherence to process measures and risk aversion. The impact of accreditation, PR and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative.Objectives: To assess the current evidence base on the impact of accreditation, PR and inspection on patient processes and outcomes.Results: We identified 69 studies, of which 40 were on accreditation, 24 on PR, three on inspection and two on accreditation and PR concomitantly. Identified studies reported primarily low-level evidence (level IV, n = 53) and were heterogeneous in terms of implemented programmes and patient populations (often narrow in PR research). Overall, a neutral categorization was determined in 30 articles for accreditation, 23 for PR and four for inspection. Ten of these recounted mixed results. For accreditation, a high number (n = 12) of positive research on adherence to process measures was discovered.Conclusion: The individual impact of accreditation, PR and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact health-care workers' mental health. However, it can also place other stresses on workers outside of their work. This study determines the effect of COVID-19 on symptoms of negative and positive mental health and the workforce's experience with various sources of support. Effect modification by demographic variables was also studied. Methods A cross-sectional survey study, conducted between 2 April and 4 May 2020 (two waves), led to a convenience sample of 4509 health-care workers in Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors (13.4%) and management staff (12.2%). About three in four were employed in university and acute hospitals (29.6%), primary care practices (25.7%), residential care centers (21.3%) or care sites for disabled and mental health care. In each of the two waves, participants were asked how frequently (on a scale of 0–10) they experienced positive and negative mental health symptoms during normal circumstances and during last week, referred to as before and during COVID-19, respectively. These symptoms were stress, hypervigilance, fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, flashback, difficulty concentrating, feeling unhappy and dejected, failing to recognize their own emotional response, doubting knowledge and skills and feeling uncomfortable within the team. Associations between COVID-19 and mental health symptoms were estimated by cumulative logit models and reported as odds ratios. The needed support was our secondary outcome and was reported as the degree to which health-care workers relied on sources of support and how they experienced them. Results All symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% confidence interval 11.11–13.49) during versus before COVID-19. Positive professional symptoms such as the feeling that one can make a difference were less frequently experienced. The association between COVID-19 and mental health was generally strongest for the age group 30–49 years, females, nurses and residential care centers. Health-care workers reported to rely on support from relatives and peers. A considerable proportion, respectively, 18 and 27%, reported the need for professional guidance from psychologists and more support from their leadership. Conclusions The toll of the crisis has been heavy on health-care workers. Those who carry leadership positions at an organizational or system level should take this opportunity to develop targeted strategies to mitigate key stressors of health-care workers' mental well-being. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care.Design: A multicenter pre-post intervention study.Setting: Eleven acute hospitals.Participants: Cardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation.Intervention: Care pathway covering in-hospital care from emergency services to rehabilitation.Main Outcome Measures: Hospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork.Results: Care pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on.Conclusions: Hospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context. [ABSTRACT FROM AUTHOR]

We evaluated the presence of prolonged mental health sequelae in the aftermath of a patient safety incident and the impact of a formal complaint or lawsuit on these mental health sequelae in 19 hospitals and 2635 nurses and doctors. Of 2635 respondents, 983 (37.3%) reported a complaint and 190 (7.2%) reported a lawsuit. In both doctors and nurses prolonged mental health sequelae reflecting a stressor-related disorder were highly prevalent, each well over 20% overall. They were consistently more prevalent in case of a formal complaint or lawsuit. Lawsuits showed 2-, 3- and 4-fold increases in prevalence of mental health sequelae. [ABSTRACT FROM AUTHOR]

Background: A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. Aims: The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Methods: Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal–Wallis test. A performance heat-map allowed for hospital-specific priority setting. Results: Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Conclusions: Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable. [ABSTRACT FROM AUTHOR]