Developing the EQUIPED approach to quality management using multi-grounded theory.

Aim: This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia.

Methods: Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase.

Results: Seventeen small (n = 7) and medium-large (n = 10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused).

Conclusions: The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.