Table 3 Strategies, barriers and quotes in each stage
Stage | Strategies | Barriers | Quotes |
|---|---|---|---|
1. Orientation | Involving directors There was attention for the QS before it was put into use. Those involved in the development (most directors) knew the system was coming. Training program An information meeting beforehand prepared the institutes and helped the participants and staff to gain more insight into the relevance and need of the system. | Seeing no relevance Not ready for the innovation | “We were well informed” (D1) “The outside world must be able to rely on a strong, common system.” (D2) “The system could give us more structure to actually work with improvements plans.” (D8) “I saw no relevance in using this collective system. I believe all the institutes are able to systematically monitor their quality. Paying attention to quality nationwide is good, but not to assess every institute with the same indicators, because we are all different. Benchmarking with these indicators is not possible.” (QC5) “We had little time to set a date for the information meeting. We preferred to start a little bit later with the QS.” (D9) |
2. Insight | Training program Quality coordinators were skilled enough. Professional system Participants thought this system was an improvement compared to the prior systems. The professional appearance with the informative manual helped the institutes to prepare. | Wait-and-see attitude (passive) Not everything is clear Seeing no improvement to the former situation | “I am curious about what the QS will bring to us. I will wait and see.” (D1) “What is the role of the national guidance? I don’t know what their role is.” (QC7) “It is such a comprehensive system. For me, it is too much to have an overview.” (D1) “I really need our quality coordinator, to be able to work with the system.” (D9) “For me, the purpose of the system is collecting data and showing this to the audit commission. I have no more expectations.” (D6) |
3. Acceptance | Involving directors Increased the credibility and the commitment to the system among QCs and staff Professional system Enhanced the credibility of the system and created confidence among participants and staff. | Doubts about / critical towards the system: does the system really assess quality? System does not fit at all institutes It feels imposed | “The way we can use good practices from other institutes is complicated because every institute works with their own formats and has its own structure. It is not as easy as it looks”. (QC2) “The starting point of the system is positive. What can we contribute to others and what can they contribute to us?” (D5) |
4. Change | Involving directors It was certain that the system was put into use. Training program QCs were capable of working with the system. Professional system Clear national deadlines ensured that all institutes made the same steps at the same time. In the case of problems, there was support. | Little space for flexibility Time pressure, tensions because of the deadlines and quantity of tasks Lack of new insights | “There is no flexibility, so the system is perceived as rigid.” (D9) “Finding the right documents and the problem is that sometimes there is no separate document. It is intertwined. To get that out and specify and referencing. That is difficult. So it is quite a job.” (D4) “You have to be alert not to overload people. I do have the time for it; it is my job, but most people in the organization don’t.” (QC4) “It is a pity that there is little space to argue and to explain why we make conscious choices that differ from [choices underlying] the indicators.” (QC6) |
5. Consolidating change | The institutes received no support from the national QC at the moment of the interviews. | Attention fades | “It is like a pilot light. When there is attention, it burns again, but after that, it fades away.” (QC5) |