3. Ensuring quality in longterm care The LTC sector is still struggling with definitions of quality (Cès & Coster, 2019; Zigante & King, 2019) and general standards in terms of professional roles, staffing levels, skills and grade mix, and other specifications that could serve as guidelines and requirements in tender specifications. There has recently been a general trend to move away from structural and process standards to outcome-oriented performance indicators with a focus on quality of life (Malley et al., 2016). However, this trend often remains limited to theoretical concepts, while in practice providers have to deal with cumbersome bureaucratic processes that are still falling short of establishing continuous improvement indicators. Our questionnaire therefore aimed to find out more about current developments regarding how public authorities have enshrined quality assurance and improvement processes in their own service provision, in procurement, and in contracting services out with external providers, as well as in monitoring and improvement of the services that they contract out.
41
