5. Public Reporting as a Quality Improvement Strategy

activity would influence hospital choice. Seventy-seven percent stated they were
interested in the report and it was ranked as the 6 th most important reason to choose a
hospital, but most people would seek advice about admission from their physician rather
than refuse admission based on this report (2009). 134
• Over 50 percent of outpatients surveyed at four general hospitals in South Korea (n=385)
said they would use the hospital performance information from the National Health
Evaluation Program but the average respondent rating of understanding the indicators
was 3.15 (3=fair) (2009). 130
• A survey of 104 patients or family members and 104 physicians in Iran verified that few
people (7.7 percent of patients and 11.7 percent of physicians) were aware of the grading
system and public report that exists for Iranian hospitals, that patients relied on
suggestions from relatives, and that physicians considered their patient’s economic
situation first when referring patients (2010). 135
• Three hundred thirty-seven patients undergoing surgery for the first time at three Dutch
hospitals were surveyed regarding their use of public information to select their hospital.
Patients were divided between those who had compared hospitals prior to their surgery
(21 percent) and those who did not (79 percent). Most respondents indicated they chose
their hospital deliberately, but the major factors in their decisions were previous
experiences with the hospital and their acquaintances’ previous experience; comparative
information was the lowest ranked of four choices in this regard. Patients were also asked
to choose factors important in future selections; public information of physician
experience was most important, but other aspects, such as wait time and physician
communication, had higher relative importance than other aspects included in public
reports such as quality of nursing care (2011). 128
One study examined the use of hospital public reports by health plans for contracting
decisions. It is included here as health plans are acting as representatives of patients in selecting
the plans they offer.
• Health plan executives were surveyed and asked to rate the importance of factors that
impact their contracting with hospitals. The top three factors were accreditation, location,
and price while the average rating of the quality of care indicators ranged from 3.03 to
3.67 (where 5 is very important). Thirty-three percent reported conducting their own
studies of comparative hospital quality (2003). 147
Focus Groups
Seven studies reported feedback obtained through either focus groups or a combination of
focus groups and interviews. Two of these involved physicians and administrators while five
focused on former or prospective patients.
• Professionals
o Focus groups and interviews with hospital administrators, physicians, and health
councils in Scotland found that public reporting of clinical indicators had raised
awareness of issues but that reports were not disseminated within hospitals; that while
over three-quarters of physicians knew about the reports, they could not recall seeing
the most recent report and relied on other sources to assess hospitals; and that health
councils had received no inquires about the hospital reports. 132
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