There are various ways to promote and encourage quality work in health care organizations and support the commitment and participation of people. Encouragement for improving quality can be set on various levels e.g., personal, organizational, regional or national level. According to the authors Black and Gruen there are six different categories to improve quality (Black/Gruen 2005, 222-231):

·         Education

·         Feedback of information

·         Incentives

·         Administrative structures and processes

·         Regulation

·         Legislation

Education: Here the authors mean interventions, which aim to educate health care providers to make quality improvements. Often this measure is set as the initial response to inadequate quality. There are different approaches, one of the most common include the issuing of guidelines.

Feedback of information: By making performances of health care providers transparent it can raise the awareness to implement necessary changes and improvements. There is a distinction between active and passive information, depending on whether only information is provided, or the information is also complemented with additional activities. Collecting and providing quantitative data is traditionally used as an incentive for quality improvement.

Incentives: Here Black and Gruen distinguish between financial and sociological behaviour incentives. Regarding this distinction the cost compensation for certain services attributed to financial incentives and the respect of colleagues as a sociological behaviour incentive. Usually, people tend to react to behaviour sociological incentives because normally the opinion their own peer is of great value. Incentives can be positive or negative, depending on whether they reward good quality or punish poor quality. It has been proven that people react more on positive incentives.

Administrative structures and processes: Uncoordinated services between various health care providers (e.g. community nursing service, hospital) often cause inadequate quality of care. The re-organization of workflows and processes provide a huge potential for improvements.

Regulation: External regulations can be imposed through contracts, accreditations, certifications, licensing or inspections. It is recommended that external regulations should only be imposed only when it is necessary, since it is usually associated with high financial cost. Also, this approach could cause resistance within an organization, which would be counter-productive.

Legislation: Legislative arrangements may also serve to promote and secure quality. But it is unclear whether the fear of consequences of a wrongful conduct contributes to quality improvement or supports a “defensive” behaviour of the health service providers in order to avoid risks. In this case this could reduce the quality of care for patients.

In most countries, a number of different approaches are being used. In this regard it is important to make sure that the activities complement each other.