International Journal for Quality in Health Care Advance Access originally published online on March 30, 2008
International Journal for Quality in Health Care 2008 20(3):155-161; doi:10.1093/intqhc/mzn010
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The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): An Analysis of the Pilot Implementation in 37 Hospitals
1 Quality of Health Systems and Services, WHO Regional Office for Europe, Copenhagen, Denmark
2 Avedis Donabedian Research Institute, Autonomous University of Barcelona, Spain
3 CIBER Epidemiology and Public Health (CIBERESP), Spain
4 Department of Social Medicine, University of Amsterdam, The Netherlands
5 OECD Quality Indicator Project, Paris, France
6 Johns Hopkins University, Baltimore, MD, USA
7 Center for Performance Sciences, Elkridge, MD, USA
8 Department of Public Health, University of Nantes, Nantes, France
9 Medical Information, Evaluation and Public Health Unit, Teaching Hospital of Nantes, France
10 Unit for Clinical Quality and Patient Safety, Central Jutland Region, Danish National Indicator Project, Aarhus, Denmark
Objective. To evaluate the pilot implementation of the World Health Organization Performance Assessment Tool for Quality Improvement in hospitals (PATH).
Design. Semi-structured interviews with regional/country coordinators and Internet-based survey distributed to hospital coordinators.
Setting. A total of 37 hospitals in six regions/countries (Belgium, Ontario (Canada), Denmark, France, Slovakia, KwaZulu Natal (South Africa)).
Participants. Six PATH regional/country coordinators and 37 PATH hospital coordinators.
Intervention. Implementation of a hospital performance assessment pilot project.
Outcome measure. Experience of regional/country coordinators (structured interviews) and experience of hospital coordinators (survey) with the pilot implementation.
Results. The main achievement has been the collection and analysis of data on a set of indicators for comprehensive performance assessment in hospitals in regions and countries with different cultures and resource availability. Both regional/country coordinators and hospital coordinators required seed funding and technical support during data collection for implementation. Based on the user evaluation, we identified the following research and development tasks: further standardization and improved validity of indicators, increased use of routine data, more timely feedback with a stronger focus on international benchmarking and further support on interpretation of results.
Conclusions. Key to successful implementation was the embedding of PATH in existing performance measurement initiatives while acknowledging the core objective of the project as a self-improvement tool. The pilot test raised a number of organizational and methodological challenges in the design and implementation of international research on hospital performance assessment. Moreover, the process of evaluating PATH resulted in interesting learning points for other existing and newly emerging quality indicator projects.
Keywords: evaluation, hospitals, indicators, performance assessment, World Health Organization
Address reprint requests to: Oliver Groene, Avedis Donabedian Research Institute, Autonomous University of Barcelona, Spain and CIBER Epidemiology and Public Health (CIBERESP). Tel: +34-93-207-66-08; Fax: +34-93-459-38-64; E-mail: ogroene{at}fadq.org
Accepted for publication February 25, 2008.