The document discusses performance evaluation of hospitals, which is essential to ensure health services are effective and efficiently using limited resources. It describes evaluating hospitals based on the amount and quality of work, costs, and patient satisfaction. Performance is evaluated through indicators to identify areas for improvement. Methods include indirect analysis of factors influencing care quality and direct analysis of medical records. Clinical audits also evaluate patterns of care quality and resources usage by analyzing topics like diagnostic tests, medical records, and patient satisfaction. The goal is continuously improving patient care and outcomes.

1. PERFORMANCE EVALUATION OF
HOSPITALS

2.  Evaluation is essential to all health service
activities.
 It is important to try to find out whether a particular
institution or a programme is serving its purpose.
Equally important is to determine whether a
particular procedure is effective, efficient and really
achieving the desired objective.

3.  Used effectively performance evaluation can
result in wide ranging benefits for both patients and
clinicians by ensuring the best use of limited
resources and continuously improving the quality of
care.
 Quality of care though difficult to measure in
absolute terms, generally can be referred to as care
or services according to accepted professional
standards.

4.  The application of performance indicators, is the
first step to initiate the performance appraisal of the
hospital.
 The outcome of a hospital operation i.e, service
(medical care) can be evaluated in terms of:
1. The amount of work done, is it optimal,
minimal or maximal
2. The quality of work performed how good is
the service.
3. Cost of care to the patient and cost of hospital
operation.
4. The extent to which patient is satisfied/
impact of medical care on population served
by the system.

5. PURPOSE OF EVALUATION
 The objectives of evaluation of hospital
performance are-
1. To plan future course of action based on a
known baseline with a view to improve
quantum and quality of care.
2. Regulatory – ensuring the full effective
utilization of staff and facilities available
3. To assess effectiveness of health programme
put into practice.

6. ORGANIZATION OF EVALUATION
 It is essential that the clinical and administrative
staff are able to identify and understand complex
problem areas to facilitate recognition of trouble
spots easily.
 Prerequisites- The framework of hospitals
information system should be so organized that
there is rapid and regular feed-back of
information.(hospital operational statistics) can be
grouped under 3 heads-
1. Resources of hospitals
2. Utilization of hospital resources
3. Administrative and financial data

7. METHODS OF EVALUATION
 It is not possible to establish accurate standards of
judgment. However evaluating the service can be
done by 2 methods-
1. Indirect method: which considers the
structure or the factors, that influence the
efficiency of medical care, such as staff
physical facility and equipment.
2. Direct method: which is concerned with
quantitative and qualitative analysis of
medical records

8.  Effective use of bed (as a measure)
 Evaluation of quantum of work done
 Evaluation of quality of care
 Direct Method- Professional work evaluation
 Cost of care evaluation
 Consumer satisfaction evaluation
 Collection and presentation of data, daily, quarterly
and annually,

9. CLINICAL AUDIT
 Audit should include measurement of current
practice, and definition of explicit standards and
implementing changes which benefits patients,
clinical should imply patient centered and involving
more than one clinical profession(the experience of
the patient is the unifying factor)
 Purpose –
 To improve quality of patient care
 To further professional education and training.
 To promote the effective use of resources

10.  Limitations-
 The boundaries of audit have to be fixed
 Organization –
 Peer group
 Structure
 Policies
 Approaches-
 Principals
 Topic selection
 Methods

11.  Resources – fix the amount of time to be devoted
to the audit, normally 5 % of clinical time.
 Are clinical records are accessible?
 Are statistics on case mix, accurate, up-to-date and
readily available
 Are facilities available to staff to access literature
 Identify staff available to support clinical audit.
 Define responsibility and funding to training.
 Identify the source and application of existing funds.

12. Methods of Clinical Audit
 Audit should involve the objective peer review of
patterns of care, be sensitive to the expectations of
patients and other clinical disciplines and be based
on scientific evidence of good medical practice.
 Adverse Patient Events or Occurrence screening
involves the systematic identification and analysis
of events during a patients treatment which may
indicate some lapse in the quality of care.

13.  Clinical Indicators: monitoring of routinely
generated data within a speciality, in order to
identify exceptions or trends which may merit
detailed ad hoc review
 Topic Review: Analysis of an agreed topic may be
carried out by a prospective study or by
retrospective analysis of patient records
 Medical Records: Clinical guidelines for minimum
standards of records be made available checklists
for evaluating records
 Therapeutics: Prescribing audit of drug usage is
valuable both clinically and economically. Such
audit also highlights some of the problems of
implementing and maintaining change in clinical
pratice.

14.  Entry: On what criteria are patients selected?
 Process: How should the treatment be conducted?
 Exit: When should treatment cease?
 The calibration and safety of equipment used by
doctors is central to the overall quality of medical
care.
Diagnostic Investigations
 Radiology: Audit of the use of diagnostic
radiology is indicated by evidence of clinically
unproductive ‘routines’ in many specialities, by
potential savings in inconvenience to patients,
staff time and hospital costs, and by the growing
concern over exposure to medical radiation.
20%of X-rays are clinically unhelpful

15.  Post-Mortem Examination: Autopsy findings are
consistently reported to differ substantially from
ante mortem diagnosis in 10 to 25%of cases—
indeed the ultimate audit.
 Random Case Review
 Patient Satisfaction
 Comparative Audit