Quality evaluation and indicator comparison in health care.

By 2005 all healthcare organizations in Europe will be required to take part in a quality evaluation scheme and to collect data about the quality of their service. Hospitals and doctors will need to prove they are safe--quality is no longer assumed. These were the predictions of a recent workshop of Nordic quality experts. The pressures to assess quality are increasing, and there are many assessment, certification, accreditation and measurement schemes in use. Which is best? What evidence is there that any have been effective? How should a hospital or region introduce such a scheme? There are many proponents for different schemes, and an increasing amount of experience to help answer these questions, but little research. This paper provides an overview for non-specialists of the different quality evaluation and indicator schemes for inspection and improvement. It draws on the experiences of quality specialists and leaders in each Nordic country who have applied the schemes in public hospitals and healthcare services. How a scheme is introduced and used may be more important than which particular scheme is chosen. This is one conclusion of the Nordic workshop. Other conclusions are that there is a need for clinicians to be involved, a need to balance simplicity and low cost with scientific validity and credibility with clinicians, and a need for research into different schemes to discover their costs and benefits in healthcare.