PERFORMANCE EVALUATION OF HOSPITALS

Evaluation is essential to all health service activities.

It is important to try to find out whether a particular institution or a programme is serving its purpose. Equally important is to determine whether a particular procedure is effective, efficient and really achieving the desired objective.

Used effectively performance evaluation can result in wide ranging benefits for both patients and clinicians by ensuring the best use of limited resources and continuously improving the quality of care.

Quality of care though difficult to measure in absolute terms, generally can be referred to as care or services according to accepted professional standards.

The application of performance indicators, is the first step to initiate the performance appraisal of the hospital.

The outcome of a hospital operation i.e, service (medical care) can be evaluated in terms of:

1. The amount of work done, is it optimal, minimal or maximal

2. The quality of work performed how good is the service.

3. Cost of care to the patient and cost of hospital operation.

4. The extent to which patient is satisfied/ impact of medical care on population served by the system.

PURPOSE OF EVALUATION The objectives of evaluation of hospital

performance are-1. To plan future course of action based on

a known baseline with a view to improve quantum and quality of care.

2. Regulatory – ensuring the full effective utilization of staff and facilities available

3. To assess effectiveness of health programme put into practice.

ORGANIZATION OF EVALUATION It is essential that the clinical and

administrative staff are able to identify and understand complex problem areas to facilitate recognition of trouble spots easily.

Prerequisites- The framework of hospitals information system should be so organized that there is rapid and regular feed-back of information.(hospital operational statistics) can be grouped under 3 heads-

1. Resources of hospitals 2. Utilization of hospital resources3. Administrative and financial data

METHODS OF EVALUATION It is not possible to establish accurate

standards of judgment. However evaluating the service can be done by 2 methods-

1. Indirect method: which considers the structure or the factors, that influence the efficiency of medical care, such as staff physical facility and equipment.

2. Direct method: which is concerned with quantitative and qualitative analysis of medical records

Effective use of bed (as a measure) Evaluation of quantum of work done Evaluation of quality of care Direct Method- Professional work

evaluation Cost of care evaluation Consumer satisfaction evaluation Collection and presentation of data, daily,

quarterly and annually,

CLINICAL AUDIT Audit should include measurement of current

practice, and definition of explicit standards and implementing changes which benefits patients, clinical should imply patient centered and involving more than one clinical profession(the experience of the patient is the unifying factor)

Purpose – To improve quality of patient care To further professional education and training. To promote the effective use of resources

Limitations- The boundaries of audit have to be fixed

Organization – Peer group Structure Policies

Approaches- Principals Topic selection Methods

Resources – fix the amount of time to be devoted to the audit, normally 5 % of clinical time. Are clinical records are accessible? Are statistics on case mix, accurate, up-to-date

and readily available Are facilities available to staff to access literature Identify staff available to support clinical audit. Define responsibility and funding to training. Identify the source and application of existing

funds.

Methods of Clinical Audit Audit should involve the objective peer

review of patterns of care, be sensitive to the expectations of patients and other clinical disciplines and be based on scientific evidence of good medical practice.

Adverse Patient Events or Occurrence screening involves the systematic identification and analysis of events during a patients treatment which may indicate some lapse in the quality of care.

Clinical Indicators: monitoring of routinely generated data within a speciality, in order to identify exceptions or trends which may merit detailed ad hoc review

Topic Review: Analysis of an agreed topic may be carried out by a prospective study or by retrospective analysis of patient records

Medical Records: Clinical guidelines for minimum standards of records be made available checklists for evaluating records

Therapeutics: Prescribing audit of drug usage is valuable both clinically and economically. Such audit also highlights some of the problems of implementing and maintaining change in clinical pratice.

Entry: On what criteria are patients selected? Process: How should the treatment be

conducted? Exit: When should treatment cease? The calibration and safety of equipment used

by doctors is central to the overall quality of medical care. Diagnostic InvestigationsRadiology: Audit of the use of diagnostic

radiology is indicated by evidence of clinically unproductive ‘routines’ in many specialities, by potential savings in inconvenience to patients, staff time and hospital costs, and by the growing concern over exposure to medical radiation. 20%of X-rays are clinically unhelpful

Post-Mortem Examination: Autopsy findings are consistently reported to differ substantially from ante mortem diagnosis in 10 to 25%of cases—indeed the ultimate audit.

Random Case Review Patient Satisfaction Comparative Audit