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

Author

Listed:
  • Nikola Kadoić

    (Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, HR-42000 Varazdin, Croatia)

  • Diana Šimić

    (Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, HR-42000 Varazdin, Croatia)

  • Jasna Mesarić

    (Faculty of Health Sciences, Libertas International University, Trg J.F. Kennedy 6b, HR-10000 Zagreb, Croatia)

  • Nina Begičević Ređep

    (Faculty of Organization and Informatics, University of Zagreb, Pavlinska Cesta 2, HR-42000 Varazdin, Croatia)

Abstract

Quality of public hospital services presents one of the most important aspects of public health in general. A significant number of health services are delivered due to public hospitals. Under the World Bank program “Improving Quality and Efficiency of Health Services: Program for Results”, the competent bodies in Croatia aimed to identify the top 40% best-performing public acute hospitals in Croatia, based on a clinical audit in the preceding 12 months. This paper presents how this goal was achieved, using a multi-criteria decision-making (MCDM) approach. A MCDM approach was selected due to the multidimensionality and complexity of healthcare performance and service quality. We aimed to develop a methodology for ranking top-performing hospitals at the national level. We chose the composite indicator methodology, combined with the analytic hierarchy process (AHP) as a tool for determining weights for aggregation of individual indicators. The study looked at three clinical entities: acute myocardial infarction, cerebrovascular insult, and antimicrobial prophylaxis in colorectal surgery. Indicators for each entity were evidence-based, following the national guidelines, but limited by availability of data. The clinical audit and databases of competent administrative bodies were used as sources of data. The problem investigated in this paper has a significant impact at the strategic (national) level. Even though the AHP has already been applied in the public health domain, to the best of our knowledge, this is the first application of the AHP in combination with composite indicators for hospital ranking at a national level. The AHP enabled participation of experts from the audited hospitals in the assessment of indicator weights. Results show that composite indicators can be successfully implemented for acute hospital evaluation using the AHP methodology: (1) the AHP supported a flexible structuring of the problem; (2) the resulting complexity of pairwise comparisons was appropriate for the experts (consistency ratios were under 0.1); (3) using the AHP approach enabled a successful aggregation of different opinions into group priorities; (4) the developed methodology was robust and enabled identifying the top 40% ranking best-performing public acute hospitals in Croatia combining 20 criteria within three entities, based on input from 36 clinical experts. The proposed methodology can be useful to other researchers for assessment of healthcare quality at the strategic level.

Suggested Citation

  • Nikola Kadoić & Diana Šimić & Jasna Mesarić & Nina Begičević Ređep, 2021. "Measuring Quality of Public Hospitals in Croatia Using a Multi-Criteria Approach," IJERPH, MDPI, vol. 18(19), pages 1-28, September.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:19:p:9984-:d:641009
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    References listed on IDEAS

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    1. Johanna Vásquez & Sergio Botero, 2020. "Hybrid Methodology to Improve Health Status Utility Values Derivation Using EQ-5D-5L and Advanced Multi-Criteria Techniques," IJERPH, MDPI, vol. 17(4), pages 1-18, February.
    2. Thomas L. Saaty, 1986. "Axiomatic Foundation of the Analytic Hierarchy Process," Management Science, INFORMS, vol. 32(7), pages 841-855, July.
    3. Sergio Domínguez & María Carmen Carnero, 2020. "Fuzzy Multicriteria Modelling of Decision Making in the Renewal of Healthcare Technologies," Mathematics, MDPI, vol. 8(6), pages 1-46, June.
    4. Necla Öztürk & Hakan Tozan & Özalp Vayvay, 2020. "A New Decision Model Approach for Health Technology Assessment and a Case Study for Dialysis Alternatives in Turkey," IJERPH, MDPI, vol. 17(10), pages 1-25, May.
    5. Mu, Enrique & Chung, Tingting Rachel & Reed, Lawrence Ian, 2017. "Paradigm shift in criminal police lineups: Eyewitness identification as multicriteria decision making," International Journal of Production Economics, Elsevier, vol. 184(C), pages 95-106.
    6. Nikola Kadoić & Nina Begičević Ređep & Blaženka Divjak, 2018. "A new method for strategic decision-making in higher education," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 26(3), pages 611-628, September.
    7. Liberatore, Matthew J. & Nydick, Robert L., 2008. "The analytic hierarchy process in medical and health care decision making: A literature review," European Journal of Operational Research, Elsevier, vol. 189(1), pages 194-207, August.
    8. Ho, William, 2008. "Integrated analytic hierarchy process and its applications - A literature review," European Journal of Operational Research, Elsevier, vol. 186(1), pages 211-228, April.
    9. Saaty, Thomas L., 2003. "Decision-making with the AHP: Why is the principal eigenvector necessary," European Journal of Operational Research, Elsevier, vol. 145(1), pages 85-91, February.
    10. Ho, William & Ma, Xin, 2018. "The state-of-the-art integrations and applications of the analytic hierarchy process," European Journal of Operational Research, Elsevier, vol. 267(2), pages 399-414.
    11. M. Saisana & A. Saltelli & S. Tarantola, 2005. "Uncertainty and sensitivity analysis techniques as tools for the quality assessment of composite indicators," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(2), pages 307-323, March.
    12. Daniel Adelman, 2020. "An Efficient Frontier Approach to Scoring and Ranking Hospital Performance," Operations Research, INFORMS, vol. 68(3), pages 762-792, May.
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