Quality Framework Responsible Care - BioMed Central

2 Starting-points for the set of indicators
The parties involved have used a number of starting-points in the development of
the Testing/Quality Framework. You van read up on these in the Testing framework
Responsible Care, November 2005 (see reference 3). We shall deal with the most
important ones below.
2.1 Process or result
In measuring quality or performance a distinction is made between measuring structure aspects (with
the aid of structure indicators), process aspects (with the aid of process indicators) or results (with the
aid of result indicators) (see reference 6). An example of a structure aspect is the (infra) structural
characteristics of care, like the availability of materials to prevent decubitus. Process aspects in this
example would be whether or not to work along a decubitus guide line. An outcome, in this case,
would be the number of clients suffering from decubitus ulcers to a certain degree at a certain
moment. The starting-point for the quality framework with the standards for Responsible Care is that
as much as possible is measured for results. The underlying idea is that how care professionals and
organisations provide care should not be reported in detail, but that certain results are realised.
Structure or process indicators having a direct relation with the result to be monitored can be applied
where there are no result indicators available (or difficult to measure).
2.2 Indicator or standard
In making the standards for Responsible Care operational, indicators have been formulated that cover
significant areas of Responsible care. We see the indicator as the ‘yard stick’ with which we can attain
an indication of the quality of care. The indicator does not say what good care is about. To decide
what good care is we need to link a standard to the indicator. However, we explicitly propose not to
formulate a minimum standard as this has a number of profound disadvantages:
• Minimum standards, in practice, often function as ‘maximum standard’ (e.g. in discussions on
finance), which consequently affects internal control;
• Minimum standards generate futile discussions like “What is a maximally acceptable decubitus
percentage?”
• Discussions on minimum standards harm the image of the sector;
• Minimum standards, together with all effects mentioned, are extremely demotivating for
professional caregivers and organisations.
That is why the Quality Framework has coupled ‘relative standards’ to indicating ‘best practices’. The
scores of care providers (relevantly corrected) are divided in percentiles or quartiles per indicator. This
will lead to an average per indicator and a best practice. A target standard can consequently be fixed
to this best practice or a best practice from literature. Comparison of every organisational unit with
the best practice generates powerful stimuli for improvement. Moreover, working towards maximum
quality is good for the image of the sector and does justice to the work of professionals.
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Quality Framework Responsible Care - Nursing, Care and Home Care