Operationalizing Quality Measurement in Long-Term Care: A Policy Review and Phased Implementation Framework for...

Long-term care (LTC) is becoming a strategic priority for health systems facing population ageing, multimorbidity, frailty, and increasing demand for coordinated medical and social support. Greece faces these pressures in a context of fragmented governance, limited formal LTC capacity, heavy reliance on family care, and quality oversight that remains largely compliance-oriented rather than performance-oriented. This policy review aims to translate international and national evidence into an operational framework for measuring and improving LTC quality in Greece.

The review combined a structured search of peer-reviewed literature, international policy reports, statistical sources, and Greek legislative and regulatory texts with a pragmatic feasibility assessment of candidate indicators.

Evidence from OECD and EU systems suggests that mature LTC quality systems share four operational features: legally mandated reporting, standardised indicators, public transparency, and use of data for provider-level improvement. For Greece, the analysis identifies major gaps in legal reporting obligations, data interoperability, workforce monitoring, public reporting, and user-experience measurement. We propose a three-tier indicator framework covering safety, clinical care processes, workforce and staffing, person-centredness, access and equity, efficiency, governance, and digital readiness. Implementation should proceed through a five-year roadmap: foundation, scale-up, and consolidation. Provider-level dashboards and a National LTC Quality Observatory are recommended as key mechanisms for transforming data into continuous quality improvement.

A phased, feasible, and legally anchored approach could strengthen patient safety, dignity, operational efficiency, and accountability in Greek LTC.