Evaluation of 60 continuous quality improvement projects in French hospitals.
OBJECTIVE
To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations.


METHODS
The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice.


METHODS
ANAES in collaboration with French public hospitals.


METHODS
A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management.


METHODS
ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits.


METHODS
Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders.


RESULTS
Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects.


CONCLUSIONS
ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.
Maguerez
G
G
Agence Nationale d'Accréditation et d'Evaluation en Santé, Paris, France.
Erbault
M
M
Terra
J L
JL
Maisonneuve
H
H
Matillon
Y
Y
D001291:Attitude of Health Personnel; D005602:France; D006302:Health Services Research; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010346:Patient Care Management; D015397:Program Evaluation / Q000379:methods*; D017751:Safety Management; D017749:Total Quality Management / Q000458:organization & administration*