Text: Anne-Claude Griesser, Assistant Medical Director at the CHUV
Photo: Chloé Pracchinetti

“Quality of care should not be reduced to one or two indicators”

Patients frequently ask how they should choose their hospital. It is a legitimate question, but there is no simple answer.

Any ranking that suggests that you should choose your hospital based on two or three quality indicators (e.g. infection rates, patient satisfaction or mortality rates) reflects a simplistic approach to patient care.

Facilities should have an overall quality assessment including structure indicators, such as available equipment, certified intensive care, staff expertise and continuous training. Organisation methods that promote teamwork and the best care at the right time, such as in neurovascular units and breast centres, should also be integrated. Another aspect to factor in is the way in which best practices are implemented to prevent infections and operating room safety.

The volume of activity performed by the hospital is another important factor in the quality of care. Hospitals need to reach a critical mass to gain experience and maintain expertise with the best results for both surgery and the treatment of certain diseases. We must find ways to help people form an objective opinion using indicators based on rigorously and statistically proven methods. That’s not so easy.

Experts recommend publishing relevant figures that reflect the quality of services. Data must be precisely defined in order to be compared using consistent collection methods and then adjusted for risks that account for patient complexity. For example, consider the infection or mortality rate. Leading hospitals that care for complex and seriously ill patients will naturally have a higher complication and mortality rate than a clinic that accepts elective patients for less complicated procedures, and that can transfer patients to a top hospital in the event of a problem. These differences must be taken into account when evaluating quality indicators.

Finally, indicators must be understandable for patients, with clear explanations about their implications, limits and interpretation. ⁄