MARQuIS - Methods of Assessing Response to Quality Improvement Strategies

The MARQuIS Project was funded by the European Commission (project details, including partners, here).

The objectives of the MARQuIS project were to research and compare different quality improvement (QI) policies and strategies in healthcare systems across the member states of the European Union (EU), and to consider their potential value when patients cross borders to receive healthcare. This research was intended to enable an evaluation of the need for, and development of, formal quality procedures at the EU level for healthcare services.


The project aimed to :

  • Assess the value of different quality strategies
  • Identify and collate the quality requirements for national health care providers when contracting care for patients from providers in other countries
  • Examine how a representative sample of individual hospitals in seven countries apply national quality strategies
  • Reach conclusions about the links and differences among national quality requirements, and the need to develop formal quality procedures at the EU level



  • Provision of evidence to assist in the further development of formal quality procedures for health care institutions at EU level
  • Specific recommendations for an EU quality system for the movement of patients across national borders
  • General recommendations for future policy developments in health care quality strategies.


Below you can find documents, articles and links relevant to the Project. 

Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project                                                                   - Editorial by R Sunol, P Garel and A Jacquerye (BMJ Journal Qual Saf Health Care 2009)

Quality Requirements for Cross-Border Care - A Qualitative Study; Oliver Groene.

Volume and diagnosis: an approach to cross-border care in eight European countries - Vallejo et al (BMJ article)

Impact of quality strategies on hospital outputs - Sunol et al (BMJ article) 

Implementation of patient safety strategies in European hospitals - Sunol et al (BMJ article)

National quality improvement policies and strategies in European healthcare systems - Spencer & Walshe (BMJ article) 

Developing a quality improvement maturity index for hospitals - Rupp, Lombarts et al

Application of Quality Improvement Strategies in European Hospitals - Rupp, Lombarts et al 

An Approach to Cross-Border Care in 8 European Countries - Vallejo, Sunol et al 

Clinical Governance & Practice in European Hospitals - Charles D Shaw

Cross-Border Care: Patient, Professionals & Financiers' Perspectives - Groene, van Beek, Klazinga et al

Do European hospitals have quality and safety governance systems and structures in place? - Shaw et al

Learning from MARQuIS - Shaw, Sunol et al 

MARQuIS - FINAL REPORT - Sunol and Vallejo.

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