Using quality measures for quality improvement: the perspective of hospital staff

Asgar Aghaei Hashjin; Hamid Ravaghi; Dionne S Kringos; Uzor C Ogbu; Claudia Fischer; Saeid Reza Azami; Niek S Klazinga

doi:10.1371/journal.pone.0086014

Using quality measures for quality improvement: the perspective of hospital staff

PLoS One. 2014 Jan 23;9(1):e86014. doi: 10.1371/journal.pone.0086014. eCollection 2014.

Authors

Asgar Aghaei Hashjin¹, Hamid Ravaghi², Dionne S Kringos³, Uzor C Ogbu³, Claudia Fischer⁴, Saeid Reza Azami⁵, Niek S Klazinga³

Affiliations

¹ Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands ; Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, Iran.
² Health Management and Economic Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, Iran ; Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, Iran.
³ Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands ; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
⁵ Development and Supervision Management of Public Affairs, Tehran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, Iran.

Abstract

Research objective: This 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 design: A 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 studied: 93 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 findings: On 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).

Conclusions: 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. 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Cross-Sectional Studies
Economics, Hospital
Hospitals / standards
Humans
Personnel, Hospital*
Quality Improvement*
Quality Indicators, Health Care
Surveys and Questionnaires

Grants and funding

This work was supported by Tehran University of Medical Sciences, Iranian Ministry of Health and Medical Education. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.