Patient satisfaction is not absolute measure for quality of care. There is a need to combine it with other measures to get insight. Patient safety measures should be considered in this regard beside statistics of nosocomial infections, deaths ratio and...

A very difficult thing to do.

Objectively measured outcomes by an OUTSIDE team might be best.

Observers in surgery. Fake paients presenting to ER with classic symptoms of a rare disease.Video recording covertly.

Chart reviews are close to useless. Patients are influenced by appearances & "perceptions".

Infections are frquently "overlooked", mortalities masked by expeditious transfers.

I agree with Alan that Chart reviews are useful. Inappropriate prescribing and consequences are very good indicators. In this field you can conclude clinical pharmacist in to the detection of inappropriate prescribing. This is very difficult topic, because many prescribers feel threatened after detection. However, this system should be establish within each hospital, unfortunately it is not true for most European hospitals. Why is not true? I often ask myself why. Maybe there are no so many complains about this topic than in U.S. Every manager should tend to establish this sytem within the hospital. This is not very easy, especailly in Eastern and Central Europe, where there are no clinical pharmacists on the hospitals' wards.

If I sum up, there are many inappropriate prescribing cases within each hospital, however they are often not reported to the committee or patients. In addition, what is scarce, is that the healt care proffesionals are often threatened after detection. This issue should be solved by the managers and owners and patients. First step towards this process is to put clinical pharmacists on the wards and establish appropriate mechanism, which detect, measure and report inappropriate prescribing.

Dear Professor Muayyad,

There are five different types of measurement the hospital quality of care and performance as:

Regulatory inspection, surveys of consumers’ experiences, third-party assessments, statistical indicators, internal assessments.

I think the "Quality measures" assess care across the full continuum of health care delivery. It can be used to measure safety, patients fall, performance improvement……etc. These measures accuracy results are varied; I think,in a case of satisfaction using different methods to measure and from different perspectives is better.

Generally quality measures fall into four broad categories: 1) structure, 2) process, 3) outcome, and 4) patient experience. I think both qualitative and quantitative studies are important in assessing these categories in the field of measuring quality in health care.

** Kindly find the attached references related to the same topic…. Ghadeer Dweik

Find the attachments please.

Dr Muayyad, a survey will be useful to measure the quality of health care.  Here are 2 papers that may be helpful, and you can contact the authors on RG for insights.

Article Quality in Health Care: Strategic Issues in Health Care Mana...

Article Perceived quality of health care services among people with ...

I think the best method is to use outcome research, even though it is complex since there are many confounding variables and its not conducted under controlled conditions.

The best book address discuss outcome research is for Kane:

Kane, R. L. (2006). Understanding Health Care Outcomes Research, (2nd) ed. 

Dear Dr Muayyad

I agree whit Ghadeer. Both  qualitative and quantitative approach are useful  in measuring quality in health care. Mix Method is convenience. Considering of context is important.

In the US, US News and World report takes it upon themselves to rank the top 100 hospitals in the US.  This website gives you information on what they look at and how they come to the rankings.  I've seen professional articles compare the US News rankings with other methods and then stand up to scrutiny.  That's not say there are not better methods that I haven't read about.  http://health.usnews.com/health-news/best-hospitals/articles/2015/07/21/best-hospitals-2015-16-an-overview

Thank you Dr. Madelaine, and all friends and colleagues who shared their answers. actually, , your input will lead to better understanding how to measure the quality of care in hospitals. Your ideas will be considered in future research. 

Dear professor Muayyad

I share my experience and I hope to be useful.

I've been quality improvement manager in a hospital  for five years and I admit that is a very difficult task. My experience in this field is  planing by cooperation of personnel and head-nurse/ manager in each section of the hospital. For planing at first, identify the quality problems and  determine priorities . The aims was to propose for each problem and to any Special objective indicator was determined. Interview is very important to identify the problems and possible indicator. This is reason of my emphasis on context.  Then data collection methods and responsibility and time period should be determine. Determination of the current indicator and the expected value for a specified time period for comparison and evaluation is essential. The success of this approach depends on monitoring and active engagement in the process.

.

Hi Professor Muayyad,

This is not filed of research. But, I touched on this during my doctoral studies. The quality of healthcare can be measured by assessing outcomes of healthcare.  There are indicators of healthcare that can be assessed. Examples of these include the duration of hospitalisation. Patient satisfaction is one aspect. The indicators are complex and varied. This paper could give an idea.

http://intqhc.oxfordjournals.org/content/15/6/523

 I hope this could help

Quality of health services can be assessed through patient feedback and scales are available for that on the net for evaluation of services provided by public or private hospitals .

Dear Myavati,

yes there are many studies which evaluated health quality with different scales, the evaluation is not the thing which we are looking for here!! the question is different. thanks

Assessment of the quality of health care provided in the hospital setting is having a paramount importance. It is important to be aware whether the doctors or other supportive staff are well trained according to the need of patients. Right person at the right place or not. Employee is according to the post position & well motivated or not. It is not a question of the patient's satisfaction.But satisfaction of the worker is also very much required.For assessment, we can prepare a scale which cover all the aspect of the health care i.e, related to health care providers as well as the receiving end (patients) , money material and time also. 

This is a huge question and a huge field...there is lots of literature out there but can I offer two frameworks to start thing about it:

The classic Donabedian "Structure-Process-Outcome" (which identifies multiple aspects of quality and potential points of measurement. In the UK over recent years the NHS has often arrived at a formulation that divides quality over the dimensions of: experience, effectiveness and safety.  There are other ways of looking at it, but a matrix based on these two frameworks will quickly demonstrate that quality is multi-dimensional and needs to be measured and treated in that way. Patient satisfaction / experience is important, but it can't be taken in isolation. At a system level equity and access should also be considered.

I realise that I haven't really answered your questions about sample, but until you have determined dimensions to be assessed and specific indicators associated with these indicators you can't really adress sample. 

Dear Professor Muayyad,

The absolute measure of the quality of care is patients outcomes (cure rate, complications, survival rate, length of stay, treatment received, readmission, patients' satisfaction, ..). Measuring patients outcome is somewhat complex. I think we should consider a long-term prospective research methodology to measure it accurately, with considering multiple confounders (e.g patient health status, staff experiences, pre-hospital care, after hospital care, level of educations, married status, ...). 

Ahmad     

Hi, I recommend my paper in the Journal of the European Economic Association "Can We Infer Hospital Quality from Medical Graduates’ Residency Choices?" by Matilde P. Machado, Ricardo Mora and Antonio Romero-Medina, Journal of the European Economic Association, 10-6, December 2012, 1400-1424 (a previous version available as CEPR Discussion Paper 6850). It makes a good review of the ways researchers measured quality and offers an alternative.

Hope it is useful.

Best regards

Matilde P. Machado

Dear Prof Ahmad,

A great question and one that is dear to my heart. As many others have identified quality in health care is a complex area as unlike a manufactured product health care quality is dimensionless but multifaceted concept. Therefore, before we can measure quality, one has to define quality.

There are many definitions of health care quality but the one that I will recommend is from the Institute of Medicine from US. The IOM published two seminal works in early 2000, I think, To Err is Human and The Quality Chasm which really set the benchmark is understanding and evaluating quality.

Donabedian's work in the 60's resulted in him being called the "father of health care quality" and he proposed the Structure-Process-Outcome. Since then the IOM has updated it with its six elements (safety, effectiveness, patient centeredness, timeliness, equity and efficiency). So, these provide the quality frameworks.

Therefore, if you want to measure quality, first we need to define it and then work out what part of quality do you want to measure. I think Mant wrote a really nice article comparing process and outcome indicators as reliant on one alone can be fraught with danger. Traditionally health care has relied on process measures (with an assumption that if what we do as clinicians is best practice and the outcome too will be good). However, now outcomes start to play a great role although they too carry number of limitations (whose outcome do we measure, how do we measure it, when do we measure it and what is clinically significant outcome, esp for morbidity etc).

I have written about quality and safety from an evidence-based practice perspective that might be worthwhile to review. They are attached with is response.

My best wishes for your research.

S

I agree with Saravana. Just want to add that for the quality domains of IOM you should consider to combine quantitative and qualitative research methods.

Most effective research method in assessment of quality of health care definitely mix methods.There must be a preplanned protocol and researchers bias must completely avoid.

As a follow up to my previous comment, I note that many of our peers have suggested that quantitative and qualitative research paradigms are used in tandem to assess health care quality.

I agree with this perspective as when used together quantitative and qualitative research help us to gain a complete picture of a particular issue which may not be possible if we use only quantitative or qualitative research. While quantitative helps us to identify the "how many", qualitative research can help us identify the "why".

However, I do want to flag the issue of "label" (or nomenclature) when using the term "mixed" methods. I think historically, the term "mixed" methods was used when quantitative and qualitative research was used as part of the research process. In recent times though, this has changed, especially based on the work undertaken by Creswell (https://researchrundowns.wordpress.com/mixed/mixed-methods-research-designs/), which restricts the term "mixed methods" to research which has a deliberate focus on using one or both research paradigm to address a particular topic or has a deliberate and considered focus.

If a research merely collects both quantitative and qualitative data and the reasons for using both are merely practical rather than theoretical, then it could be better labelled as "multi-method", which is indeed appropriate in measuring health care quality.

I think overtime, the distinction between "mixed method" and "multi-method" will become more clearer but in the meantime it is certainly some food for thought.

Dear Muayyad Ahmad

Quality of health care depend upon 3Ms .Human resource,Money & technology,environmental issues.Human resources are the most difficult to control when quality is not  static variable each moment it is moving up developing again by human resources.Statistically quality is always any given situation should never touch the highest point .If highest point is 4 it stand always somewhere in between 3 and 4.It will be always .Mix or multi whichever methods it always indicate improvement in certain area.Always there is a chance to improve 3Ms.

Your question is very interesting ? and historical also

Thanks to generate such question?

regards 

Dr. Saravana Kumar, 

Thanks for clarification about mixing quantitative and qualitative research paradigms

I think we may called it triangulation method too. 

Ahmad 

Dear Sir,

 there are many standard scale for measure for hospital service quality. you have to download this paper "Dimensions of hospital service quality: a critical review: Perspective of patients from global studies" 

Thank you all scholars for your answers. All are inspiring.

Actually, one of my PhD students who will defend her dissertation very soon has conducted a study in a mixed method design. The sample was only nurses who have experienced the role of being a patient. We have 2 papers under publication now. The findings are interesting and in many aspects are contradicting the availble studies that explored the public patients opinion on health care while being hospitalized. Once published, I will upload them.

A new article that measures the quality of nursing care from nurses perspectives themselves who were admited as patients or caregiver for relatives; which means nurses have experienced the role of being patients and they are most realistic individuals who can give accurate evaluation for the nursing care the received.

Measuring the quality of health care in hospitals can be done by various manner such as developing key performance indicators that will measuring structure , process and outcome and also it can be through conduct survey that measure patient experience or by accreditation .

I hate to be the one to disillusion you especially as your neat phraseology indicates a measure of altruism. I have sat in on many meetings where the Hospital Administration (who are solely concerned about their job security, and

making a profit) have decided which key performance indicators should be

cherry picked and announced to the public.Similarly, with outcomes; which

cause unintended amusement at national meetings. For example, one

Stockton Hospital had a talk on outcomes of porta caval shunts indicating

zero mortality; the very next paper was the same hospital's pathologist

who described a 25% mortality for the same group of patients! When this was

pointed out, the surgeons admitted transferring dying patients to other

hospitals.

To put it bluntly, there are lies, there are damn lies and then there are hospital

statistics.