Quality management at European hospitals
: staff perceptions of content, implementation and effects in elderly-related, acute stroke care in England and Germany

  • Alina Halank

Student thesis: Doctoral Thesis


The aim of this research was to analyse and compare clinical governance
and quality management initiatives at hospitals in England and Germany
in terms of content, implementation and effects as perceived by
managerial, clinical and non-clinical staff working in elderly-related, acute stroke care in order to identify ‘valued’ practice approaches and develop recommendations for overall improvement.

The research applied a comparative case-study design to address this
aim. Documentary analysis prepared the site visits. Interviews with 83
representatives of different staff groups were conducted at a pilot-case
and eight elderly-related, acute stroke care units, four of which were
located in England and four in Germany. The findings from the cross-case
analysis were compared to the views of 17 experts from England,
Germany and Florida.

The research contributes to knowledge by widening the scope of previous
research in two senses. First, the researcher applied a qualitative research
design and interviewed a wider spread of different professions, including
managers, consultants, nurses, therapists and support staff, than has
been done in previous research. Secondly, the interview questions
focused not only on the quality understanding or quality implementation
issues, but also extended the areas of discussion to include ‘valued’
practice and suggested improvements.

The findings of the case-study analysis highlight six emerging themes,
which confirm general issues from the quality management literature, such as an unclear impact on efficiency or the ‘them versus us’ phenomenon, for the hospitals.

Moreover, these themes and the general findings from the research
confirm and develop in greater detail the hospital specific issues of quality management and clinical governance. Examples include the contentious role of consultants, the need for more partnerships in healthcare and scarcity of resources. Most importantly, staff confirmed that clinical governance and quality management resulted in safer, more consistent care to better meet patient needs.

Based on these findings, recommendations were developed for four areas,
i.e. organisation-wide concerns, staff-specific issues, political and systems aspects, as well as further research.
Date of AwardAug 2011
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorDebbie Reed (Supervisor), Andreas Hoecht (Supervisor) & Michael John Wood (Supervisor)

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