The Mixed-Method 5W2D Approach for Health System Stakeholders Analysis in Quality of Care: An Application to the Moroccan Context

Abstract

(1) Background: Quality of care (QC) is not only about satisfying patients, but also about satisfying the various health system stakeholders (HSS). This makes it a complex and difficult objective to achieve. This study aims at proposing a methodological framework for identifying HSS, prioritizing them in QC, and analyzing their interrelationships. (2) Methods: The proposed framework is the mixed-method 5W2D approach, which uses a combination of three basic methods: the 5W questioning technique (What, Who, Why, Where, and When), the Delphi method, and the Decision making trial and evaluation laboratory (DEMATEL) technique. It consists of three interdependent phases. First of all, a preliminary list of HSS is established based on a systematic literature review, which is then projected and adapted to the national context using the 5W questioning technique. Secondly, the identified HSS are classified in order according to their influence and impact on QC by employing Delphi method. Thirdly, the interrelationships between HSS are determined and analyzed by applying DEMATEL technique. An application of 5W2D is conducted in the Moroccan context as its health system involves a wide range of stakeholders. (3) Results: Results defined 17 groups of HSS, whose prioritization led to three groups that are at the core of the health system: patients and their families, health personnel, and government. Roles and expectations of these groups regarding QC are divergent and contradictory, which require making trade-offs. The findings of this study intend to guide the development of inclusive strategies and policies that involve key stakeholders for QC assessment and improvement.

Designing a Transportation-Strategy Decision-Making Process for a Supply Chain: Case of a Pharmaceutical Supply Chain

“…Also, it is considered to be an effective method for gaining judgments on complex matters where precise information is unavailable [ 87 ]. In addition, the DELPHI method has been widely used to determine consensus in a number of important need areas, especially in the healthcare field [ 88 , 89 , 90 ].…”

Modeling the impact of hospital logistics on quality of care and patient satisfaction: Results of a survey in three public healthcare facilities in Fez, Morocco

“…Examples of healthcare outcomes are reduced mortality rates, restoration of function and survival, reduced hospital-acquired infections, improved patient satisfaction, etc. Furthermore, the QC should also reflect the wishes of health system stakeholders (Frichi, Jawab & Boutahari, 2019c). On that point, some researchers have proposed to link QC to stakeholder satisfaction (Bautista & Tangsoc, 2016), and particularly to the satisfaction of patients, as they are the most important stakeholder group in the health system (Frichi et al, 2019c;Symmank, Krause & Gurtner, 2015).…”

An Exploratory Qualitative Study of the Influence of Hospital Logistics Factors on Quality of Care and Patient Satisfaction at Public Hospitals in Morocco

“…This second aspect can be assessed by measuring patient satisfaction [5]. However, some authors argued that patient satisfaction is not sufficient and must include other stakeholders' points of view [6]. In this paper, quality of care is considered only in terms of patient satisfaction.…”