Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality

TY - JOUR

T1 - Steering by their own lights

T2 - Why regulators across Europe use different indicators to measure healthcare quality

AU - Beaussier, Anne-Laure

AU - Demeritt, David

AU - Rothstein, Henry

AU - Griffiths, Alex

PY - 2020/5

Y1 - 2020/5

N2 - Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country's healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.

AB - Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country's healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.

KW - Comparative health policy

KW - Healthcare quality governance and improvement

KW - Hospital quality indicators

KW - Performance measurement

UR - http://www.scopus.com/inward/record.url?scp=85081666401&partnerID=8YFLogxK

U2 - 10.1016/j.healthpol.2020.02.012

DO - 10.1016/j.healthpol.2020.02.012

M3 - Article

SN - 0168-8510

VL - 124

SP - 501

EP - 510

JO - HEALTH POLICY

JF - HEALTH POLICY

IS - 5

ER -