A FRAMEWORK TO IMPROVE QUALITY OF HOSPITAL-BASED PHYSIOTHERAPY: A DESIGN-BASED RESEARCH STUDY

R.A. Steenbruggen^1,2, M. Maas^1,3, T.J. Hoogeboom¹, P. Brand^4,5, P. van der Wees¹

¹Radboudumc, IQ Healthcare, Nijmegen, Netherlands, ²Saxion, School of Health, Enschede, Netherlands, ³HAN, Institute of Allied Health Studies, Nijmegen, Netherlands, ⁴University Medical Centre Groningen, Medical Education, Groningen, Netherlands, ⁵Isala Clinic, Medical Education, Zwolle, Netherlands

Background: In previous research, we identified quality aspects for hospital-based physiotherapy both in the eyes of hospital-based physiotherapists and their key stakeholders: patients, medical specialists, hospital managers, executive boards and co-treating professionals. We also noted that globally expanding accreditation instruments to measure quality such as JCI or Qmentum mainly focus on hospital policy and procedures and do not specifically cover a profession such as hospital-based physiotherapy. These instruments do not allow systematic quality improvement of hospital-based physiotherapy departments.^​This justifies the need for a tailored quality improvement (QI) framework for hospital-based physiotherapy.

Purpose: The aim of this study is to gain insight into which QI methods could form the design of a QI framework, as a foundation for a system to improve the quality of hospital-based physiotherapy in the Netherlands, by combining the insights of hospital-based physiotherapists and their key stakeholders.

Methods: A multidisciplinary panel of six representatives of hospital-based physiotherapy and their key stakeholders (patients, medical specialists, hospital management and professional association) was set up. We used brainwriting to sample ideas and the ‘decision-matrix’ to select the best ideas.

Results: The first round of brainwriting with an online panel of six experienced participants yielded consensus on seven possible methods for quality improvement of hospital-based physiotherapy:
(1) continuing education,
(2) feedback on patient-reported experience measures and patient-reported outcome measures,
(3) a quality passport with portfolio,
(4) peer observation and feedback,
(5) 360-degree feedback,
(6) a management information system, and
(7) intervision with intercollegiate evaluation.
Placing these methods in a decision matrix against four criteria (measurability, acceptability, impact, accessibility) resulted in a slight preference for a management information system, with an almost equal preference for five other methods immediately thereafter. The least preference was given to 360-degree feedback.

Conclusions: In the design of a framework for improving the quality of hospital-based physiotherapy, all seven suggested methods were perceived as relevant but differed in terms of advantages and disadvantages. This suggests that, within the framework, a mixture of these methods may be desirable to even out respective advantages and disadvantages.

Implications: The results of this study, summarised in the design of a framework for quality of hospital-based physiotherapy, provide a foundation to develop a quality system for hospital-based physiotherapy. For example, a national professional association for physiotherapy can use this framework to develop such a quality system.

Funding acknowledgements: none

Keywords:
Hospital-based physiotherapy
Quality improvement
Design-based research

Topics:
Professional issues
Education: continuing professional development
Education: methods of teaching & learning

Did this work require ethics approval? No

Reason: Convening and consulting a voluntary expert panel is deemed unnecessary for ethics approval according to Dutch legislation (Law on Medical-Scientific Research with human beings, section 1, article 1). All methods were carried out in accordance with relevant guidelines and regulations in the declaration of Helsinki - Ethics approval and consent to participate section. All panel members provided written informed consent.