The QUASER study (April 2010-March 2013) aims to design and disseminate an evidence based guide for hospitals to provide high quality care and implement quality and safety improvement programmes, and an evidence based framework for payers to assess and monitor the quality and safety of hospitals across the EU. This translational research aims to increase the quality and safety of healthcare in the EU and therefore will improve the health of EU citizens. In particular the research will help to address one of the main goals of the Commission that patients should be confident of the quality and safety standards of the treatment they will receive in any Member State.

The study investigates relationships between organisational and cultural characteristics of hospitals and how these impact on quality (defined as clinical effectiveness, patient safety and patient experience. Although there is a wealth of information available about quality improvement in healthcare there is little guidance available about overcoming the challenges of implementation in a complex healthcare organisation. Guidance needs to be grounded in the realities and constraints of healthcare practice. This project therefore addresses a significant need in the healthcare sector by providing guidance drawn from the everyday experiences of hospitals in the EU.

The evidence based guide for hospitals to implement quality and safety improvement programmes, and the evidence based framework for payers to assess and monitor the quality and safety of hospitals across the EU will be based on empirical findings from research in five partner countries:

• The Netherlands (Erasmus University)
• Sweden (Qulturum)
• England (King’s College London (co-ordinator), Imperial College)
• Portugal (ISCTE)
• Norway (University of Stavanger)

These countries were chosen as they represent variation in the important aspects of healthcare that the study wants to capture e.g. differences in the way that healthcare services are funded, and in the way that progress had been made in each country on the ‘quality journey’. In addition, the development of the guide for hospitals and framework for payers will be with a wider stakeholder group of other countries, through a parallel process of translational workshops involving both hospitals and payers from these countries.

A central feature of the study is to look at ‘quality’ from a multi-level perspective incorporating the macro (national healthcare system), meso (hospital) and micro (frontline clinical team) levels.

Knowing as we do that each of these levels separately and in interaction with the others, affects clinical effectiveness, patient safety and patient experience, our study will retain a particular focus on the dynamics and interactions between these different levels as possible key determinants of sustained quality of hospital care.

This multi-level perspective is operationalised by means of 10 comparative, longitudinal, hospital case studies with hospitals selected being at different stages of the “quality journey”.

Throughout the study a mixed methods approach is adopted, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims).

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