Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality
Résumé
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.
Domaines
Science politique
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