Guy Bendermacher

Internal quality assurance (IQA) is one of the core support systems on which schools in the health professions rely to ensure the quality of their educational processes. Through IQA they demonstrate being in control of their educational quality to accrediting bodies and continuously improve and enhance their educational programmes. Although its need is acknowledged by all stakeholders, creating a system of quality assurance has often led to establishing a ‘tick-box’ exercise overly focusing on quality control while neglecting quality improvement and enhancement. This AMEE Guide uses the concept of quality culture to describe the various dimensions that need to be addressed to move beyond the tick-box exercise. Quality culture can be defined as an organisational culture which consists of a structural/managerial aspect and a cultural/psychological aspect. As such this AMEE Guide addresses tools and processes to further an educational quality culture while also addressing ways in which individual and collective awareness of and commitment to educational quality can be fostered. By using cases within health professions education of both formal and informal learning settings, examples will be provided of how the diverse dimensions of a quality culture can be addressed in practice.

The concept of quality culture has gained increased attention in health professions education, drawing on insights that quality management processes and positive work-related attitudes of staff in synergy lead to continuous improvement. However, the directions that guide institutions from quality culture theory to educational practice have been missing so far. A prospective qualitative case study of three health professions education programmes was conducted to explore how a quality culture can be enhanced according to the experiences and perspectives of educational leaders. The data collection was structured by an appreciative inquiry approach, supported with vignette-based interviews. A total of 25 participants (a selection of course coordinators, bachelor coordinators and directors of education) reflected on quality culture themes to learn about the best of what is (Discover), envision positive future developments (Dream), identify actions to reach the desired future (Design), and determine how to support and sustain improvement actions (Destiny) within their own educational setting. The results are presented as themes subsumed under these four phases. The experiences and perspectives of educational leaders reveal that peer learning in teams and communities, attention to professional development, and embedding support- and innovation networks, are at the heart of quality culture enhancement. An emphasis on human resources, (inter)relations and contextual awareness of leaders stood out as quality culture catalysts. Educational leaders are therefore encouraged to especially fuel their networking, communication, coalition building, and reflection competencies.

Purpose: This study sought to identify key features of an organizational quality culture and explore how these features contribute to continuous quality improvement of undergraduate medical education. Method: Between July and December 2018, researchers from Maastricht University in the Netherlands conducted a multicenter focus group study among 6 education quality advisory committees. Participants were 22 faculty and 18 student representatives affiliated with 6 medical schools in the Netherlands. The group interviews focused on quality culture characteristics in relation to optimizing educational development, implementation, evaluation, and (further) improvement. Template analysis, a stepwise type of thematic analysis, was applied to analyze the data. Results: Five main themes resembling quality culture constituents to continuous educational improvement were identified: (1) fostering an open systems perspective, (2) involving stakeholders in educational (re)design, (3) valuing teaching and learning, (4) navigating between ownership and accountability, and (5) building on integrative leadership to overcome tensions inherent in the first 4 themes. A supportive communication climate (which can be fueled by the organization’s leaders) contributes to and is integrated within the first 4 themes. Conclusions: The results call for a shift away from static quality management approaches with an emphasis on control and accountability toward more flexible, development-oriented approaches focusing on the 5 themes of a culture for continuous quality improvement. The study provides new insights in the link between theory and practice of continuous quality improvement. Specifically, in addition to quality management systems and structures, faculty’s professional autonomy, collaboration with peers and students, and the valuing of teaching and learning need to be amplified.

To this date, research on the interplay between organisational structure/managerial and organisational value/psychological elements which impact on educational quality is scarce and fragmented. As a consequence of a lack of knowledge in this area, institutions often address these elements in isolation, moving past integral approaches, which reinforce the organisations’ quality culture. In order to examine interrelationships between context characteristics, work-related psychological attitudes of staff and enhancement practices, a path analysis was performed on data collected from academics with teaching coordination roles. The findings highlight the paramount importance of a ‘human relation’ value orientation; this orientation influences empowerment, commitment and communication satisfaction. Rational goal values and ownership are positively related to quality enhancement practices. It is advocated that institutional policies and strategies directed at educational quality enhancement should leave discretionary space for the availing of academics’ expertise. Nurturing collaborative teaching/learning communities with explicit concern for morale, involvement and development, deserves further cultivation.