DeGroote School of Business, McMaster University, Hamilton, Ontario L8S 4M4, Canada.
Int J Qual Health Care. 2024 Mar 4;36(1). doi: 10.1093/intqhc/mzae011.
Several health policy institutes recommend reducing the number of indicators monitored by hospitals to better focus on indicators most relevant to local contexts. To determine which indicators are the most appropriate to eliminate, one must understand how indicator selection processes are undertaken. This study classifies hospital indicator selection processes and analyzes how they align with practices outlined in the 5-P Indicator Selection Process Framework. This qualitative, multiple case study examined indicator selection processes used by four large acute care hospitals in Ontario, Canada. Data were collected through 13 semistructured interviews and document analysis. A thematic analysis compared processes to the 5-P Indicator Selection Process Framework. Two types of hospital indicator selection processes were identified. Hospitals deployed most elements found within the 5-P Indicator Selection Process Framework including setting clear aims, having governance structures, considering indicators required by health agencies, and categorizing indicators into strategic themes. Framework elements largely absent included: adopting evidence-based selection criteria; incorporating finance and human resources indicators; considering if indicators measure structures, processes, or outcomes; and engaging a broader set of end users in the selection process. Hospitals have difficulty in balancing how to monitor government-mandated indicators with indicators more relevant to local operations. Hospitals often do not involve frontline managers in indicator selection processes. Not engaging frontline managers in selecting indicators may risk hospitals only choosing government-mandated indicators that are not reflective of frontline operations or valued by those managers accountable for improving unit-level performance.
一些卫生政策研究所建议减少医院监测的指标数量，以便更好地关注与当地情况最相关的指标。为了确定哪些指标最适合被剔除，必须了解指标选择过程是如何进行的。本研究对医院指标选择过程进行分类，并分析其与 5-P 指标选择过程框架中概述的实践是否一致。这是一项定性的、多案例研究，研究了加拿大安大略省四家大型急性护理医院使用的指标选择过程。通过 13 次半结构化访谈和文件分析收集数据。主题分析将这些过程与 5-P 指标选择过程框架进行了比较。确定了两种类型的医院指标选择过程。医院部署了 5-P 指标选择过程框架中发现的大部分要素，包括明确目标、建立治理结构、考虑卫生机构要求的指标以及将指标分类到战略主题中。框架要素基本缺失包括：采用基于证据的选择标准；纳入财务和人力资源指标；考虑指标是否衡量结构、过程或结果；以及让更广泛的最终用户参与选择过程。医院在如何监测政府强制要求的指标与更能反映当地运营情况的指标之间存在困难。医院通常不让一线管理人员参与指标选择过程。不让一线管理人员参与选择指标可能会导致医院只选择政府强制要求的指标，而这些指标可能无法反映一线运营情况，或者不受负责提高单位绩效的管理人员重视。
