Developing a national framework for comparative performance evaluation of public general hospitals: Integrating clinical, financial and service-oriented dimensions of evaluation

Background: In an era in which healthcare systems are characterized by limited resources and increasing complexity, policymakers are looking for tools to evaluate and improve quality, which will assure the public of maximal quality within existing resources.

Objective: To design a national framework for comparative performance evaluation of Israel's public general hospitals (PGHs), fully integrating clinical, financial and service-oriented dimensions.

Methodology: Qualitative research based on an extensive literature review and in-depth semi-structured interviews.

Results: A multidimensional framework is proposed. The basic unit for comparison across hospitals was defined as a medical procedure or diagnosis. Accordingly, the evaluation of each of Israel's PGHs is based on an agreed, limited fixed set of key medical procedures and diagnoses in each of its main contexts (pediatrics, surgery, internal medicine, and women's health). Each medical procedure or diagnosis is simultaneously evaluated by a set of indicators in three agreed core perspectives, clinical, financial, and consumer-oriented, enabling full integration throughout the framework. A system for determining weights for each dimension reflecting key stakeholders' and professionals' points of view was designed.

Conclusions: The proposed framework will assure maximal integration between perspectives by linking all evaluation dimensions to the same core unit, consequently making it possible to assess how a change in one dimension impacts others. This infrastructure supports attaining optimization among perspectives by achieving the best balance between them. The multidimensional architecture enables policymakers to contend with the need to improve the quality of medical care and patient satisfaction within budgetary constraints.