From Inspection to Integrated Improvement: Reframing Quality Governance Through Person-Centred and Participatory Care in Europe

Abstract Quality in social care is increasingly seen as a dynamic, participatory process based on dignity, autonomy, safety, and user-defined outcomes. Traditional inspection-led models no longer meet the complex, diverse, and ethical demands of today’s societies. This paper examines a shift in quality governance through a comparative study of four leading European agencies: HIQA (Ireland), the Care Inspectorate (Scotland), the Care Quality Commission (England), and Zorginstituut Nederland (Netherlands). These were selected for their institutional maturity and their innovative, systemic approaches to quality assurance. Drawing on documentary analysis and thematic synthesis, the study shows how these bodies move from rule-based oversight to person-centred, co-produced quality improvement. Despite varying legal frameworks, all embed user participation, integrate lived experience into regulation, and use outcome-based tools, such as patient-reported outcome measures (PROMs) and value-based benchmarking. Quality is reframed not as a technical metric but as a relational and ethical responsibility. The paper argues that this evolving model aligns with guidance from the Organisation for Economic Co-operation and Development (OECD) and the European Social Network, offering insights for national reforms that seek inclusive, rights-based, and responsive care systems.