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


METHODS
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.


METHODS
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.


RESULTS
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.
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.
Asgar
A
Aghaei Hashjin
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.
Hamid
H
Ravaghi
Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands.
Dionne S
DS
Kringos
Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands.
Uzor C
UC
Ogbu
Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands ; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Claudia
C
Fischer
Development and Supervision Management of Public Affairs, Tehran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, Iran.
Saeid Reza
SR
Azami
Department of Social Medicine, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands.
Niek S
NS
Klazinga
D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004469:Economics, Hospital; D006761:Hospitals / Q000592:standards; D006801:Humans; D010564:Personnel, Hospital; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires