Abstract
Research objectiveThis study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals.Study designA cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators.Population studied93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran.Principal findingsOn average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05).ConclusionsThere is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level.
Highlights
Measuring quality of care is a powerful mechanism to drive health system performance improvement
There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes
Organizational, clinical process, clinical effectiveness, patient safety, and patient centeredness indicators were reported to be used by 75%, 57%, 66%, 72%, and 86% of the respondents respectively (p,0.05)
Summary
Measuring quality of care is a powerful mechanism to drive health system performance improvement. Numerous health systems are in the process of developing and instituting requirements for routine measurement and reporting of quality data at both national and hospital levels for external and internal purposes [1,2,3,4]. Quality indicators can be used for summative (external) purposes to increase the accountability of hospitals towards different stakeholders (such as; government, patients or health insurers). They can be used for formative (internal) purposes by health care organizations and providers to measure, monitor and improve the provided levels of quality of care [5,6]
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