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Elsevier’s The Best Hospitals 2010

SiRM has supported the weekly publication Elsevier in their study on The Best Hospitals 2010 according to performance indicators and other publicly available data on Dutch hospitals. Performance indicators were selected for the study, as well as care-related indicators, such as information on waiting times, on the financial situation of a hospital and on patient experiences (CQ-Index). The hospitals and specialists themselves were involved in developing care-related indicators, which are, for instance, also used by the Health Care Inspectorate for purposes of supervision and by insurers in purchasing hospital care. Care-related indicators are divided into the areas of effectiveness, safety and patient orientation. The scores in these three domains, together with waiting lists, determine the position of the facility in the Elsevier study on The Best Hospitals (figure 1).

Figure 1

We selected 356 of the 795 available indicators from the basic set and the safety set of the Health Care Inspectorate and tranche 1 of the Dutch Health Care Transparency Programme (Zichtbare Zorg). Almost all indicators from the hospital-wide indicator sets are included in the selection, as are a large portion of indicators for acute care delivered by all hospitals. In the case of disease-specific elective care, only those indicators are selected from indicator sets that say something about the quality of the whole hospital and not just one specific disease (figure 2). No indicators were selected for which a case mix correction is still necessary. Ultimately, 104 indicators were selected for elective care.

Figure 2

Different indicators are combined to constitute other indicators in this study. Indicators were first re-scaled to a uniform scale (z-score) and were then weighted and added up. Weightings have been established together with Elsevier. The relationship in weight between structure, process and outcome indicators has been specified as 1:1.5: 2. Hospitals that failed to provide information receive the lowest scored values

The score of a hospital is expressed in one to four bullet points. The bullet points do not reflect a value judgment on the part of SiRM or Elsevier, but indicate how the hospital scores in selected indicators compared to the average in the Netherlands. The data thus does not qualify hospitals as ‘good’ or ‘bad’ in an absolute sense. In the case of indicators in which coincidence plays a role, we bear in mind statistical reliability. The score of a hospital and the confidence interval together determine the number of bullet points for a hospital. The hospitals can also score half points for the indicators.

A combination of five indicators reflecting information from simple annual financial statements is used for the hospitals’ financial situation. The annual reports have been collected and analyzed by SiRM. Waiting times are compared only for specialties and treatments offered by all hospitals. The hospital admission CQ-Index is used for clients’ experiences.

See also The Best Hospitals 2010 on Elsevier’s website (in Dutch).

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