A descriptive study of the implementation of the EFQM excellence model and underlying tools in the Basque Health Service.

OBJECTIVE To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service. DESIGN Prospective, descriptive observational study. SETTING Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain. METHODS Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model. RESULTS Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in 'processes'. The overall patients' satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center. CONCLUSIONS Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.