Time to have a paradigm shift in health care quality measurement.

Quality measurement is important to stakeholders in providing valid information for improvement, and has been associated with hospital accreditation in most countries. The commonly used categories of indicators are structure, process, and outcome. Outcome indicators are of foremost importance as they reflect the effect of health care; structure indicators are commonly used for assessing capacities or facilities available for providing services, whereas process indicators assess how well the service is delivered, and provide essential and important information for quality improvement. For a process indicator to be valid, it should be linked to an outcome, whereas a structure indicator must be linked to a better outcome. Although there are no strict rules for usage or selection of indicators, it is important to ensure adequate coverage of relevant domains of the health care services intended to be evaluated. Because the trends in health care services and management are changing, it is time to have a paradigm shift in health care quality measurement. Although evaluating the quality had also been extended to include quality of life and patient satisfaction, the ultimate aim of health care services should be "staying healthy, getting healthy, and living healthy". It is important for physicians to learn how to use these clinical indicators for improving service performance and organizational growth.