title: How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.
abstract: OBJECTIVE
  There is an increasing demand for the use of quality indicators in palliative care. With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation.
  
  
  METHODS
  Three focus group interviews were organized with 21 caregivers from 18 different specialized palliative care services in Belgium. Four had already worked with the indicators during a pilot study. The focus group discussions were transcribed verbatim and analyzed using the thematic framework approach.
  
  
  RESULTS
  The caregivers anticipated that a positive attitude by the team towards quality improvement, the presence of a good leader, and the possible link between quality indicators and reimbursement might facilitate the implementation of quality indicators in specialized palliative care services. Other facilitators concerned the presence of a need to demonstrate quality of care, to perform improvement actions, and to learn from other caregivers and services in the field. A negative attitude by caregivers towards quality measurement and a lack of skills, time, and staff were mentioned as barriers to successful implementation.
  
  
  CONCLUSIONS
  Palliative caregivers anticipate a number of opportunities and problems when implementing quality indicators. These relate to the attitudes of the team regarding quality measurement; the attitudes, knowledge, and skills of the individual caregivers within the team; and the organizational context and the economic and political context. Training in the advantages of quality indicators and how to use them is indispensable, as are structural changes in the policy concerning palliative care, in order to progress towards systematic quality monitoring.
authors.affiliation: End-of-Life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. kleemans@vub.ac.be.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Leemans
authors.affiliation: End-of-Life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.|Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: End-of-Life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.|Heymans Insitute, Department of Pharmacology, Ghent University, Ghent, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|NIVEL. Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.affiliation: End-of-Life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.|Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: End-of-Life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium / Q000453:epidemiology; D017028:Caregivers / Q000458:organization & administration / Q000523:psychology / Q000706:statistics & numerical data; D003144:Communication Barriers; D017144:Focus Groups; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D010465:Perception; D010865:Pilot Projects; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000592:standards; D011795:Surveys and Questionnaires
keywords: Disincentives; Incentives; Palliative care; Qualitative research; Quality assessment; Quality improvement; Quality indicators
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