title: Measuring healthcare quality: the challenges.
abstract: OBJECTIVE
  Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework and an organizational setting in which valid and reliable healthcare information can be produced to inform the general public about healthcare quality.
  
  
  METHODS
  To improve health care quality information, the paper explores the analogy between financial accounting, which aims to produce valid and reliable information to support companies informing their shareholders and stakeholders, and healthcare aiming to inform future patients about healthcare quality. Based on this analogy, the authors suggest a measurement framework and an organizational setting to produce healthcare information.
  
  
  RESULTS
  The authors suggest a five-quality element framework to structure quality reporting. The authors also indicate the best way to report each type of quality, comparing performance indicators with certification/accreditation. Health gain is the most relevant quality indicator to inform the public, but this information is the most difficult to obtain. Finally, the organizational setting, comparable to financial accounting, required to provide valid, reliable and objective information on healthcare quality is described.
  
  
  CONCLUSIONS
  Framework elements should be tested in quantitative studies or case studies, such as a performance indicator's relative value compared to accreditation/certification. There are, however, elements that can be implemented right away such as third party validation of healthcare information produced by healthcare institutions.
  
  
  CONCLUSIONS
  Given the money spent on healthcare worldwide, valid and reliable healthcare quality information's value can never be overestimated. It can justify delivering "expensive healthcare, but also points the way to savings by stopping useless healthcare. Valid and reliable information puts the patient in the driver's seat and enables him or her to make the right decision when choosing their healthcare provider.
authors.affiliation: Reinier de Graaf Hospital, Delft, The Netherlands. heuvel@rdgg.nl
authors.forename: Jaap
authors.initials: J
authors.lastname: van den Heuvel
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Niemeijer
authors.forename: Ronald J M M
authors.initials: RJ
authors.lastname: Does
mesh_terms: D000068:Accreditation / Q000458:organization & administration; D019985:Benchmarking / Q000458:organization & administration; D006801:Humans; D009426:Netherlands; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*