Multiple case study of processes used by hospitals to select performance indicators: do they align with best...

Area of Science:

• Health Services Research
• Healthcare Management
• Quality Improvement Science

Background:

• Health policy institutes advocate for reducing hospital performance indicators to enhance focus on local contexts.
• Understanding indicator selection processes is crucial for identifying appropriate indicators for elimination.
• The 5-P Indicator Selection Process Framework provides a model for effective indicator selection.

Purpose of the Study:

• To classify hospital indicator selection processes.
• To analyze the alignment of these processes with the 5-P Indicator Selection Process Framework.
• To identify gaps and challenges in current indicator selection practices.

Main Methods:

• Qualitative, multiple case study design.
• Involved four large acute care hospitals in Ontario, Canada.
• Data collection via 13 semistructured interviews and document analysis, followed by thematic analysis.

Main Results:

• Two distinct hospital indicator selection processes were identified.
• Hospitals commonly implemented elements like clear aims, governance, mandated indicators, and strategic themes.
• Key absent elements included evidence-based criteria, finance/HR indicators, structure/process/outcome considerations, and broad end-user engagement.
• Hospitals face challenges balancing mandated versus local indicators and often exclude frontline managers.

Conclusions:

• Hospital indicator selection processes partially align with the 5-P framework but have significant gaps.
• Excluding frontline managers risks selecting indicators misaligned with operational realities and unit-level performance needs.
• Improving indicator selection requires greater engagement of end-users and incorporation of evidence-based criteria.