Table 1 Components of the implementation strategy used for the QS and their intended effects

Directors decide to develop and use a collective QS, and they are involved in the development of the system

Developers design the system in a systematic and thoughtful manner.

There is an informative manual, a web-based system for data management, enthusiastic (organizational) support, and clear national deadlines.

Before launch, there is a presentation including a clear explanation of the purpose of the QS.

All quality coordinators (QCs) receive training in how to work with the web-based system.

The audit commission receives a 1-day professional training.

A national quality coordinator supports the institutes.

Stage1. Orientation

There is attention for the system before it is put into use.

Those involved know the system is coming.

The presentation and training sessions provide the participants with more insight into the relevance of the system.

Stage 2. Insight

The informative manual will help to prepare the institutes.

QCs are skilled enough.

Stage 3. Acceptance

Increases the credibility and the commitment to the system.

A professional system will enhance the credibility of the system and create confidence.

Expectations and responsibilities are clear.

Involving others in the training sessions leads to more support.

Stage 4. Change

It is certain that the system will be put into use.

Clear national deadlines ensure that all institutes take the same steps at the same time.

In the case of problems, there is support.

QCs are capable of working with the system.

Stage 5. Consolidating change

The national quality coordinator supports the institutes with implementing improvement plans.