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J Edu Health Promot 2020,  9:63

Identification of common indicators of hospital performance evaluation models: A scoping review

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Date of Submission29-Sep-2019
Date of Acceptance12-Nov-2019
Date of Web Publication31-Mar-2020

Correspondence Address:
Bahram Delgoshaee
Department of Health Services Management, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jehp.jehp_563_19

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BACKGROUND: Hospitals in developed countries allocate itself about 40% of health-care costs and in developing countries up to 80%. In this study, researchers reviewed the related article in the field of the hospitals' performance evaluation due to the identification of common indicators used in different models with the aim of providing simple list for evaluating hospitals' performance to the researchers who are interested to these issues.
METHODS: The databases for the search included Medline, Google Scholar, and Scopus. A search strategy leads to the extraction of 403 related articles that after the removal of inappropriate and duplicate articles, 42 studies were selected for the scoping review.
RESULTS: This scoping review showed that 9 of 42 selected articles use data envelopment analysis model, 6 of them Pabon Lasso model, 3 of them balanced scorecard, 3 of them organizational excellence model, and the remaining articles used key performance indicators to evaluate hospital performance. A process approach was used to categorize the common indicators because the literature review indicated that common indicators mainly evaluate data, process, output, or impact of performance. The findings included 36 input, 39 process, 27 output, and 8 impact common indicators for evaluating performance.
DISCUSSION: This scoping review of related literature indicated that despite differentiation in the time and place of past studies in the field of performance evaluation models, there are some indicators that are common in most popular performance evaluation models. These simple lists can apply for evaluation of hospitals' performance instead of complicated models.

Keywords: Evaluation, hospital, performance

How to cite this article:
Rasi V, Delgoshaee B, Maleki M. Identification of common indicators of hospital performance evaluation models: A scoping review. J Edu Health Promot 2020;9:63

How to cite this URL:
Rasi V, Delgoshaee B, Maleki M. Identification of common indicators of hospital performance evaluation models: A scoping review. J Edu Health Promot [serial online] 2020 [cited 2021 Jan 16];9:63. Available from: https://www.jehp.net/text.asp?2020/9/1/63/281661

  Introduction Top

In developed countries, hospitals allocate about 40% and in developing countries up to 80% of health-care costs. Therefore, the results of hospitals' performance in the health-care system are a great priority.[1]

On the other hand, based on the literature review, more than half of national health resources are wasted in different countries, especially in underdeveloped countries, which means limited resources are inefficiently consumed or national income is spent on services that are not proportionate and effective. Therefore, ensuring the quality of health-care services requires evaluating the performance of health-care organizations to alleviate some of the government's financial problems by minimizing waste.[2] Therefore, many health-care providers have stepped to path of performance evaluation in order to achieve their goals and missions.[3]

In fact, these organizations consider performance evaluation models as a way to move toward continuous improvement and valid tool for measuring of the organization's current performance.[4]

On the other hand, an appropriate and applicable evaluation model for hospital performance potentially would lead to more accountability, service quality, and satisfied customer. When a hospital's performance is not evaluated, any claims about its service quality will be unproven, and there is no evidence to improve performance. Therefore, the evaluation and improvement of performance are two sides of the same coin that will lead to continued improvement, and the lack of an efficient performance evaluation will lead to serious problems for hospitals from the aspect of responsibility and performance improvement. Until two decades ago, designing a performance evaluation system was just a mere innovation, but today, it has become an indispensable necessity for any organization. With all these interpretations, the evaluation of performance is very complex and difficult to done, which requires pay attention to all various dimensions of performance that would affect the job results.[5]

The WHO's definition of performance is achieving the desired goals. The excellent hospital performance should be based on professional competence in benefit from the latest knowledge, advanced technology and of course regarding available resources, efficiency of resource, minimum risk for patient, and patient satisfaction. In other words, according to literature review, the performance evaluation is not worthwhile alone and will be valuable if the results of that used to continually improvement of performance.[6]

Today, several models to evaluate the performance of an organization have been introduced such as models of organizational excellence (European Foundation for Quality Management) that evaluates the performance of organizations for establishing total quality management[7] or the balanced scorecard (BSC) approach that transforms the organization's strategic goals into measurable indicators and establishes a balanced distribution across the organization's critical areas. This approach, as a measurement system while operationalizing the organization's vision and strategies, can provide a comprehensive picture of the organization's performance. In other words, a balanced scorecard can play an effective role in realizing the vision and strategy of an organization using a set of financial and nonfinancial indicators.[8]

Other ways to evaluate hospitals' performance are the use of key performance indicators (KPIs). In some studies, the performance of hospitals was evaluated by identifying and measuring KPIs.[9]

Organizations that apply any evaluation's models to measure its performance at first should identify some of the effective indicators. Improving hospital indicators means efficiency and effectiveness in hospital activities, in other words, best use of resources.[10] So far, many studies have been conducted to evaluate the performance of hospitals in different countries. In this study, we have attempted a scoping review of studies carried out over the past 10 years (2018–2008) on the performance evaluation of hospitals using different methods in Iran and other countries to reach common evaluation indicators.

  Methods Top

In recent years, many studies have been conducted to evaluate the performance of health-care organizations in different countries. Therefore, because of the large number of studies in this field, the search strategy limited to the 10-year period (2008–2018). Furthermore, with regard to the purpose of the study, which was a scoping review of studies conducted in the field of hospital performance, the researchers excluded studies that done in other health-care organizations. Therefore, the keywords used to search the related articles were as follows: Performance Evaluation, Hospital, Performance Evaluation Models, and Performance Evaluation Methods [Table 1].
Table 1: Search strategy

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The databases used for the search included Medline, Google Scholar, Scopus, EBSCO Discovery Service, and Web of Science [Table 2]. A search of these databases leads to the extraction of 403 articles that, after the removal of duplicate and non-English articles, 123 articles with screening criteria (keywords in the title or abstract of the articles) were selected. Furthermore, in order to focus on the main purpose of the study, literature that evaluated the results of performance evaluation without using a specific model were excluded. After rescreening, studies that were repeated in the EndNote X7 for windows because of the use of the snowball method in references also were excluded. Finally, 42 studies were extracted for the scoping review [Figure 1].
Table 2: Inclusion and exclusion criteria

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Figure 1: Screening process of articles

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After the final review of extracted articles, the selected articles were reviewed using the matrix method – a system for organizing, critically evaluating, and synthesizing research articles for scientific review of articles. Inclusion criteria were also used for reviewing and evaluating relevance articles. A scoping review is done to attain to deep perspective of a selected topic, not to evaluate or criticize the best study that have been counducted. Therefore, the studies were reviewed by a researcher, away from any critical review and weighting of the studies.

  Results Top

After screening the studies, 42 studies that met the inclusion criteria were carefully reviewed. The characteristics of these studies are summarized in [Table 3] by target population, study location, research method, and time of study.
Table 3: Descriptive of reviewed articles

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Out of 42 selected articles, 18 were published in other countries [Table 4] and 24 in Iran [Table 5], 9 of them use data envelopment analysis,[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] 6 of them Pabon Lasso model,[8],[18],[19],[20],[21],[22] 3 of them BSC,[23],[24],[25] 3 of them organizational excellence model,[4],[7],[26] 3 of them used accreditation standards,[27],[28],[29] and other articles used KPIs to evaluate hospital performance.[1],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42] The Pabon Lasso model was used for the evaluation of hospital performance only in Iran in determined time period. In two studies, combined models were used for performance evaluation, and in some studies, performance evaluation indicators have been used; these indicators were hospital mortality rates and readmission rates as performance evaluation indicators.
Table 4: Descriptive of English reviewed articles

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Table 5: Descriptive of Persian reviewed articles

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After reviewing the indicators used in hospitals' performance evaluation-related literature review, a process approach was used to categorize the common indicators in most applied performance evaluation models because the literature review indicated that common indicators are main kind of indicators to evaluate data, process, output, and impact of performance. This category is summarized in [Table 5].

  Discussion Top

Much has been echoed in the literature about the importance of understanding performance. According to industrial models of production, where the efficiency of production is paramount, some researchers have proposed that health care could be viewed under the same magnifying glass as the production of other goods.

Nevertheless, in many countries, the hospital environment has completely changed in the past 20 years compared to industrial zone, so health-care organizations have been forced to apply continued performance improvement approaches to survive in competitive environment. Therefore, seeking to comprehensive, reliable, strategic, and flexible model to evaluate performance has become an important priority and an undeniable responsibility for them. As mentioned above, health-care management and health-care industry have been one of the popular and complex topics that many researchers and professionals have focused on. In this study, researchers reviewed studies conducted over 10 years (2007–2017) with the aim of extracted common indicators of evaluating hospital performance.

For as much as in hospitals such as other organizations, services are delivered through determined processes and the researchers decided to summarize and categorize the common indicators in the format of process components (data, process, output, and impact) [Table 6]. In the articles reviewed, different indicators were used in varied model applied for hospitals' evaluation, but a scoping review confirms this point that despite difference among performance evaluation models, common indicators are the main body of all reviewed models.
Table 6: Effective indicators on hospital performance evaluation in a process format

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Therefore, the researchers in this study tried to gather indicators that were mainly used in previous related literature to evaluate the performance of hospitals to guide the practice of those interested in this kind of topics.

Study novelty

In this study researchers tried to obtaining a simple but comprehensive list of indicators that commonly used for hospital performance evaluation instead of complex performance evaluation models.

Study limitation

Researchers in this study tried to extracted related articles but some of them were not available because of publisher or journal rules so, researchers for overcoming this limitation replaced the most similar ones.


this research was part of Ph.D. thesis of the first author that was financially supported by grant number IUMS/SHMIS-1395.9221532202.

Financial support and sponsorship

This article is the part of the first author thesis that financial by grant number IUMS/SHMIS-1395/9221532202

Conflicts of interest

There are no conflicts of interest.

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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