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As the health‐care industry undergoes major change, a method of “accounting for quality” has become a key factor in health services delivery and fiscal accountability. This article examines several aspects of health care that inhibit the development of common methods of defining and accounting for quality. Key issues and characteristics of the health‐care market are addressed and the article provides a synthesis of these obstacles to the process of deriving common measures and standards of quality that may be utilized by the health‐care industry for financial decisions.

Purpose – The numbers of health care transparency initiatives are increasing. Despite the growing availability of quality data, there seems to be a shortage of evidence about the effects and effectiveness of such initiatives. The aim of this systematic review is to document the effects of transparency, defined as the public release of quality performance data, on hospital care outcomes.

Design/methodology/approach – Through a review of the literature, we chose 46 keywords to use in our searches and focused on empirical studies published in English between 2010 and 2015. The use of combinations of these keywords in searches of four databases (PubMed, Scopus, Web of Science, and the Cochrane Library) generated 13,849 publications. The removal of duplicates and exclusion of studies that were not empirical or not relevant to transparency and quality resulted in 39 studies to be reviewed.

Findings – Our review of the literature confirmed the growth of health care transparency efforts, led by the United States, and found mixed results regarding the effects of transparency on hospital care outcomes. For example, mortality, the most frequently researched performance measure (n = 15), exhibited this mixed pattern by having studies showing a reduction (n = 4), increase (n = 1), mixed findings (n = 4), and no significant relationship (n = 6) as a result of public release. We also found a limited number of articles related to unintended consequences of public reporting. When compared with earlier systematic reviews, there seems to be a trend in the reduction of unintended consequences. Therefore, we recommend exploration of this potential trend in future studies empirically.

Practical Implications – The research findings summarized in this systematic review can be used to understand the results of existing transparency efforts and to develop future transparency initiatives that may better enhance hospital quality performance.

Originality/value – This is the latest and most comprehensive systematic review summarizing the effects of transparency of quality metrics on hospital care outcomes.

Outcome measurement is a key priority for services. There are no papers on specific overall quality outcome measures for people with intellectual disabilities who have dementia. The purpose of this paper is to describe the development and piloting of a new measure.

A process was developed to measure quality outcomes across all stages of dementia. The reliability of the tool was measured using Cronbach’s α coefficients, along with data about its clinical utility.

The QOMID has good reliability, face validity and internal reliability suggesting that all domains contribute equally towards the construct of quality outcome. An exploratory factor analysis revealed that there may be four or five sub-factors within the QOMID, The clinical utility of the assessment tool was explored and it can be concluded that the QOMID is simple, fairly quick and effective.

The scale has good psychometric properties and the initial parameters for the QOMID were met. Further exploration of factors needs to be considered with a larger sample of participants.

The scale was liked by assessors and gives a practical tool that can both measure the quality outcome for people at each stage of their dementia, and help to develop more effective care plans.

This is the first measure to look at quality outcomes for people with intellectual disabilities and dementia and which takes a staged approach.

The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety.

Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes.

The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model.

This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors’ knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

Attention has been increasingly devoted to the development of methods for assessing the quality of care in long‐term care (LTC) facilities, especially for government surveillance. A study is described which used the tracer method to provide data on the quality of care in Israeli LTC institutions. Advantages of the tracer method include its incorporation of structural, process and outcome measures and its focus on a number of representative tracer conditions. The study tested the ability of the tracer method to provide data on the quality of care, and facilitated adoption of this methodology by the government for their annual inspections.

The purpose of this paper is to develop and test a modified service quality (SERVQUAL) model scale for measuring healthcare service quality in Kosovo.

An initial dimensions area methodology in construct development, followed by combined exploratory-analytical deductive research with the goal to test theory concepts and validate the measurement tool known from the theory of service quality using new empirical data in a specific context. A cross-sectional survey on a sample of 200 post-encountered patients and using structural equation modelling (SEM) and SEM path analysis to determine satisfaction.

The findings confirmed that a six-dimensional scale of SERVQUAL is not appropriate for the Kosovo health-care context. The scale development analysis with a new reduced four-dimensional model can be used to measure health service quality in the Kosovan context.

The initial study concept was not piloted. It was developed by the researcher based on secondary data. Systematic random sampling was used, which may have resulted in conclusions that are not applicable to the general population. Finally, this study is applicable to the Kosovo context and cannot be generalized nor represent all patients treated in Kosovo hospitals and clinics. However, the above limitations are less significant compared to the importance of carrying out this type of study for the first time in Kosovo.

This study can help Kosovo health authorities to guide health system-wide improvements and health-care providers to remove quality shortfalls based on a culturally sensitive and validated multiple-item scale for the quality of their service.

This is the first research conducted to identify which of the service quality dimensions require attention by the health-care service providers in Kosovo and develop a validated tool for patient satisfaction measurement that can be used for commercial application.

The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.

This study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.

Using California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.

Taken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.

Report cards, performance evaluations, and quality assessments continue to penetrate the lexicon of the healthcare sector. The value of report cards is typically couched as enhancing consumerism among patients, increasing accountability among healthcare providers, and more broadly increasing the transparency of healthcare information. This paper discusses the potential benefits and pitfalls of these performance assessments.

This paper briefly reviews empirical evidence regarding the impact of report cards for healthcare providers and synthesizes the role and limitations of these performance measures into distinct evaluation criteria. The rapid proliferation of report cards for healthcare providers suggests a growing need to develop mechanisms and tools to evaluate their impact. The risks associated with utilizing report cards for provider oversight include the deleterious impact on vulnerable populations and a failure to accurately measure quality of care. The capacity to create report cards should not be the sole criterion to develop and utilize report cards to evaluate healthcare providers. Rather, careful consideration of the benefits and risks should accompany the implementation and utilization of report cards into regulatory processes. This report proposes an evaluation checklist by which to assess the role of report cards in a given healthcare context.

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

The purpose of this paper is to consider some notions that are currently in use in integrated care, with the aim of exploring whether these notions improve the quality and integration of care.

Notions like “continuity of care”, “coordination of care”, “team‐working” and “partnerships” are some of the wide variety of terms increasingly employed within the range of initiatives and efforts that aim to enhance the quality of health and social care environments for patients and users. While each of these notions seems to represent a worthy cause in the quest for better care, and is accompanied by varying extents of evidence of its effectiveness, conceptual clarity of each notion remains a challenge. This paper undertook a detailed examination of what each of these notions comprises, how it is measured objectively and subjectively, whilst highlighting any apparent overlap between the notions.

From the analysis of the four notions, two main patterns of dysfunctional features emerged: the first pattern involved issues of multiple, imprecise and constricted definitions; the second pattern had to do with imprecise or conflicting assessments of how the different notions or dimensions thereof are related to one another.

A review of the literature suggests that the meanings, and consequently the measurement, of these notions could benefit from less ambiguity in order to prevent confusion about what precisely is being implemented and measured.

In order that calls for quality improvement do not become slogan statements, there is an urgent need for integrated framework(s) that add clarity to an already compound web of notions. This could contribute to improving the quality of research and evidence base of this complex field.