There are a number of hospital performance indicators that can be used. The World Health Organization mentions several dimensions that need to be covered:3
(i) Clinical effectiveness-technical quality, evidence-based practice and organization, health gains, outcomes (individual and community)
(ii) Patient centeredness-responsiveness to patients; client orientation (prompt attention, access to social support, quality basic amenities, choice of provider); patient satisfaction; patient experience (dignity, confidentiality, autonomy, communication)
(iii) Production efficiency-resources; finance (financial systems, continuity, wasted resources); staffing ratios; technology
(iv) Safety-patients and providers, structure, process
(v) Staff-health, welfare, satisfaction, development (e.g., turnover, vacancy, absences)
(vi) Responsive governance-community orientation (answers to needs and demands), access, continuity, health promotion, equity, ability to adapt to the evolution of the population's demands (strategy fit).
A sample M&E form, adopted from a Department of Health form, is in Annex 12. There is also a hospital monitoring tool produced by a foreign-funded project in 2002.4 It is extensive and uses a grading system to rate a hospital's performance. The PhilHealth Benchbook, familiar to many provincial hospital managers, also monitors service quality and can be used as a basis for M&E for quality of service. There are commonalities in the dimensions that these tools cover. However, the provincial government should bear in mind that contract terms, which are not included in the existing monitoring tools, must be included in the monitoring for the PPP in hospital management.
The sample management monitoring tool in Annex 12 includes both general management and clinical management aspects of hospital management. The goal of general management (administration, finance, marketing, etc.) is to ensure that the clinical staff can deliver clinical services without any problems. Failure to do so will result in inadequate or inefficient clinical services (e.g., lack of drugs and medicines, lack of supplies, unnecessary referrals, etc). Clinical and medical services are also monitored to ensure that a certain level of service quality is maintained. Their indicators include infection rates, net death rates, etc. Good hospital management is thus a marriage of good general and clinical management, and most monitoring tools include aspects of both.
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3 World Health Organization, Regional Office for Europe. 2003. Measuring Hospital Performance to Improve the Quality of Care in Europe: A Need for Clarifying the Concepts and Defining the Main Dimensions. Report on a World Health Organization Workshop, in Barcelona, Spain, on 10-11 January.
4 Management Sciences for Health. 2002. Hospital Reforms: The Hospital Performance Monitoring Tool. Health Sector Reform Technical Assistance Project.