"This translational study aims to design and disseminate an evidence based guide for hospitals to implement quality and safety improvement programmes, and an evidence based framework for payers to assess and monitor the quality and safety of hospitals across the EU. These outputs will be based on empirical findings from research in five partner countries. However, in addition, the development of these outputs will be with a wider stakeholder group of other countries, through a parallel process of translational workshops involving both hospitals and payers from these countries. The proposed study will take place in five European countries: Netherlands, Sweden, UK, Portugal and Norway. These countries were chosen as they represent variation in the important aspects of healthcare that we want to capture e.g. differences in the way that healthcare services are funded, and in the way that progress had been made in each country on the ‘quality journey’. By means of scoping reviews of published and grey literature, we will identify organisational and cultural characteristics which previous studies have linked to the effectiveness, safety and patient experience of hospital care and quantitative and qualitative indicators of the effectiveness, safety and patient experience of hospital care. Using results of this work, we will develop analytical tools and protocols to conduct in-depth, longitudinal case studies in a selected sample of 10 hospitals, two in each of the five partner countries. This will include building on previously published research to compare the macro-level (national) health care contexts of the five partner countries. We will then conduct a meso-level study of organisational characteristics and cultures and their relationship with available measures of the effectiveness, safety and patient experience of hospital care; and a micro-level longitudinal study of two clinical micro-systems in five of the 10 hospitals (one in each of the five partner countries). T"