A novel method for measuring health care system performance: Experience from QIDS in the Philippines

Abstract

Objectives Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q*, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q*was developed, implemented in hospitals in the Philippines and how it compares with typical measures. Methods Q*consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q*using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q*. Results Q*was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2 years. We found Q*to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled US2133 or US305 per assessment per site. Conclusion Q*appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings.