MEASURING HOSPITAL PERFORMANCE TO …

1 Regional Office for Europe_____ EUR/03/5038066 ENGLISH ONLY UNEDITED E78873 MEASURING HOSPITAL PERFORMANCE TO IMPROVE THE quality OF CARE IN EUROPE: ANEED FOR CLARIFYING THE CONCEPTS AND DEFINING THE MAIN DIMENSIONS Report on a WHO Workshop Barcelona, Spain, 10-11 January 2003 SCHERFIGSVEJ 8 DK-2100 COPENHAGEN DENMARK TEL : +45 39 17 17 17 FAX : +45 39 17 18 18 TELEX: 12000 EMAIL. : WEBSITE: 2003 2 ABSTRACT The World Health Report 2000 stressed that the organization, configuration and delivery of services impact on the PERFORMANCE of the overall health system PERFORMANCE . The current restructuring of health care services among European countries both Western and Eastern countries highlights the importance of efficient HOSPITAL organization throughout Europe.

2 The development of new common policy orientations, focusing on the demand for accountability and quality improvement strategies, and a growing interest in patient satisfaction assessment, are incentives for developing HOSPITAL PERFORMANCE assessment. A workshop organized in Barcelona by the WHO European Office for Integrated Health Care Services the 10-11 January 2003 discussed conceptual issues, definitions and concepts of HOSPITAL PERFORMANCE measurement and practical issues as the principles for designing and developing benchmarking networks dedicated to measure HOSPITAL PERFORMANCE and promote the improvement of quality of care. The following conclusions were reached: need to have generic definitions adapted to the context of this project; definitions of key dimensions of HOSPITAL PERFORMANCE promoting a comprehensive model of HOSPITAL PERFORMANCE measurement; and recommendations regarding the design of a benchmarking network allowing participants to compare their own PERFORMANCE to peer hospitals through relevant PERFORMANCE indicators.

3 The group of experts agreed on six key dimensions for assessing HOSPITAL PERFORMANCE : Clinical effectiveness Safety Patient centredness Production efficiency Staff orientation Responsive governance The original papers of the workshop will be available on the website of the WHO European Office for Integrated Health Care Services ( ). Keywords HOSPITALS standards quality INDICATORS, HEALTH CARE standards quality OF HEALTH CARE DELIVERY OF HEALTH CARE HEALTH POLICY trends EUROPE World Health Organization 2003 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source.

4 For the use of the WHO emblem permission must be sought from the WHO Regional Office. Any translation should include the words : The translator of this document is reponsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. WHO Regional Office for Europe, Copenhagen 3 CONTENTS Page 4 HOSPITAL PERFORMANCE PROJECT .. 5 6 Models of HOSPITAL PERFORMANCE assessment .. 6 Different dimensions of HOSPITAL PERFORMANCE measurement .. 7 CONCLUSIONS .. 8 Definitions .. 8 The key dimensions of HOSPITAL PERFORMANCE measurement .. 9 Expansion of dimensions and 10 RECOMMENDATIONS .. 11 13 ANNEX 1: SCOPE AND PURPOSE .. 14 ANNEX 2: PROGRAMME.

5 16 ANNEX 3: LIST OF PARTICIPANTS .. 18 EU/01/5038066 Page 4 4 Introduction As discussed in the World Health Report 2000, the organization, configuration and delivery of services impact on the PERFORMANCE of the overall health system (1). This report introduced the concept of stewardship, stating that governments should ensure that their country s health care system provides the optimal health services for its population (2). To achieve this, emphasis should be put on the development of systems monitoring and regulating the PERFORMANCE of health care providers, especially HOSPITAL PERFORMANCE , as such systems are still poorly developed throughout Europe (3). In that perspective, hospitals deserve special attention: Hospitals are an important part of any health system: they provide complex curative care that, depending on their capacity, acts as a first referral, secondary or last referral level curative care facility; they also provide emergency care for the severely injured or the critically ill; they are centres for the transfer of knowledge and skills; they constitute an essential source of information and power; and they generally spend the major part of national health resources (4).

6 Hospitals account for the largest share of overall health expenditure, generally between 50% and 70 % of health care expenditure throughout Europe. Common trends during the ten last years in Europe include a major reduction in the number of beds (even though HOSPITAL admissions are not decreasing) and shorter lengths of stay. During this period, the volume of ambulatory care rose (5). Hospitals had to continue to adapt themselves to changes in their internal and external environments in the general context of restructuring systems (6). The development of new policy orientations, such as the demand for accountability and quality improvement strategies, or a growing interest in patient satisfaction assessment, are also incentives for developing attention to HOSPITAL PERFORMANCE assessment.

7 The concept of PERFORMANCE brings together the concepts of quality , efficiency and effectiveness of health care services. PERFORMANCE indicators can be used for internal and/or external reasons. Internal reasons are related to the various management functions of the HOSPITAL as a health services delivery organization and the indicators are used as management information to monitor, evaluate or improve the functions in the long term (strategy) or short term. External reasons are related to accountability questions asked by other stakeholders such as the financier (either insurer or State), patients/consumers and the public at large. Many nations have now integrated HOSPITAL accreditation programmes into their health care systems.

8 The basic concept of HOSPITAL accreditation among nations is similar but in fact is maturing and changing in those countries where the programmes have long been in place. HOSPITAL accreditation has always been about structure, process, and outcome but has focused mostly on the structure and process aspects. It is now the case in the United States, Australia, Canada, Europe and some other countries where the emphasis is increasingly on outcomes. It needs to be recalled, however, that the identification of a bad outcome is an indicator that there is a problem in the process or the structure. For example, in the measurement of post-operative infection, there is absolutely no meaning other than that some aspect of the process or structure lies at the root of the cause.

9 EU/01/5038066 Page 5 5 In order to develop HOSPITAL accreditation, health services need to develop close links with allies like health services research, legislators and the media. No least the latter because of the need to transfer complicated scientifically based information to decision makers and to the public (7). HOSPITAL PERFORMANCE Project The strategic orientations of WHO promote a comprehensive approach to measure HOSPITAL PERFORMANCE and encompass different dimensions of PERFORMANCE such as responsiveness, evidence based best practices and organization, continuity and integration of health care services and health promotion, focusing on patients needs. The aim of this project is to identify, based on best practices, a framework, key dimensions to measure HOSPITAL PERFORMANCE and a set of valid and reliable indicators related to these dimensions, on which they could assess voluntarily.

10 The aim is not to produce normative indicators, but to enhance the value of comparison to peer hospitals in order to promote the PERFORMANCE of services delivered to the patients in a voluntary process. Within this context a working group was set up in November 2002, gathering together European and North American experts. The mandate of this working group was to build and validate a flexible and comprehensive model of HOSPITAL PERFORMANCE assessment, allowing the implementation of benchmarking networks on HOSPITAL PERFORMANCE at the national or international level. Voluntary quality improvement is the overarching purpose of these networks. In the first meeting of the working group several issues were discussed: a) conceptual issues as definitions of HOSPITAL PERFORMANCE assessment; b) key dimensions and sub-dimensions of HOSPITAL PERFORMANCE ; and c) different models of HOSPITAL PERFORMANCE .