Measuring Quality of Public Hospitals in Croatia Using a Multi-Criteria Approach

Area of Science:

• Healthcare Management
• Public Health Policy
• Health Services Research

Background:

• Public hospital quality is crucial for national health systems.
• Identifying top-performing hospitals is essential for quality improvement initiatives.
• Croatia aimed to identify the top 40% of public acute hospitals using a World Bank program.

Purpose of the Study:

• To develop and present a methodology for ranking public acute hospitals at a national level.
• To apply a multi-criteria decision-making (MCDM) approach for healthcare performance evaluation.
• To identify the top 40% best-performing public acute hospitals in Croatia.

Main Methods:

• Utilized a composite indicator methodology combined with the analytic hierarchy process (AHP) for weighting indicators.
• Focused on three clinical entities: acute myocardial infarction, cerebrovascular insult, and antimicrobial prophylaxis in colorectal surgery.
• Data sourced from clinical audits and administrative databases, incorporating evidence-based, national guideline indicators.

Main Results:

• The AHP methodology proved effective for evaluating acute hospital performance, enabling flexible problem structuring.
• Pairwise comparisons were manageable for experts, with consistency ratios below 0.1.
• The approach successfully aggregated expert opinions into group priorities, identifying the top 40% of hospitals.
• The methodology integrated 20 criteria across three clinical entities, validated by 36 clinical experts.

Conclusions:

• Composite indicators, when combined with AHP, offer a robust method for national-level hospital performance assessment.
• The developed methodology provides a flexible, expert-driven framework for evaluating healthcare quality.
• This approach can be adopted by other researchers and policymakers for strategic healthcare quality assessment.