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The definition and implementation of best practice and quality standards in long-term care in eight European countries

Outcomes and quality United Kingdom

6 September 2012

The definition and implementation of best practice and quality standards in long-term care in eight European countries

Lisa Trigg, London School of Economics, United Kingdom


While older people often experience excellent long-term care, many challenges persist in delivering high quality care at a consistent standard. With the demand for care increasing due to a range of social and demographic factors, there is a pressing need to identify strategies to ensure that care is delivered at a consistent level of quality. Governments are increasingly focusing on outcomes as a core measurement of quality in long-term care. With this, there is a risk that the guidance on ‘what to do’ and the ‘how to do it’ can be neglected. Notwithstanding this, there are also a number of challenges with defining processes and standards which will deliver quality outcomes for users. The links between processes and outcomes are difficult to prove and effects may vary between users. In addition, gathering evidence to support the design of social care interventions is challenging due to the practical issues involved with conducting randomised controlled trials.

Even in health care, where empirical evidence is (often, but not always) more widely available, the development of guidelines is problematic. Various EU member states are adopting different approaches to the development and implementation of advice on how best to deliver different components of the social care process. Direction and advice can come in the form of quality standards and/or best practice guidelines, covering a range of distinct areas of practice. The process of development includes different stakeholders, with ownership for best practice residing in a range of governmental, regulatory and other bodies. They may or may not be formally linked to other quality standards or measures in place within the LTC environment, and may be compulsory or voluntary in nature.

This presentation will comprise the findings of a study into how eight European countries have approached the issue of designing and implementing best practice in social care. Experts in each country (England, France, the Netherlands, Germany, Ireland, Spain, Sweden and the Czech Republic) were enlisted to complete a detailed survey, which included sections on the availability of guidelines; approaches to their development and design; dissemination and implementation processes; and monitoring of their usage. Experts were also asked to identify the major challenges faced in delivering these guidelines, and what policy developments are underway in their country of expertise. A comparison of the approaches will be presented, along with common themes and policy gaps.