The impact of legislative versus non-legislative quality policy in health care: a comparison between two countries

An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown . This article explores that relationship by comparing two countries with d ifferent quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Fi nland, QM is not required by law and the responsibilities for organizing he alth care are delegated to the m unicipalities. The question is whether or not these differences in national policy are reflected in the extent and ef fectiveness of QM in health care organizations in the two countries. A cros s sectional survey was conducted in late 1999. Data about QM in both countr ies were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health car e organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and mo re patient participation were found in Dutch health care organizations comp ared with the Finnish ones. However, contrary to our expectations, the Finn ish organizations reported more perceived effects of their QM-activities. F urther analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvem ent procedures, human resource management and the flexible attitude of empl oyees showed the strongest relationship with the perceived effects of QM. T he difference between the national approach in The Netherlands and the dece ntralized approach in Finland did not, as we had assumed, result in more re gional variation in QM in Finland. Conclusions: a government's quality poli cy may have sonic influence on the extent of QM in health care organization s. However, more QM-activities do not necessarily imply more effects. Recom mendations: since QM-activities differ in the degree to which they bring ab out changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care. (C) 2001 Elsevier Science Ireland Ltd. All rights res erved.