Understanding the relationship between effectiveness and outcome indicators to improve quality in healthcare

Çınaroğlu S., Baser O.

TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE, vol.29, pp.1294-1311, 2018 (SSCI) identifier

  • Publication Type: Article / Article
  • Volume: 29
  • Publication Date: 2018
  • Doi Number: 10.1080/14783363.2016.1253467
  • Journal Indexes: Social Sciences Citation Index (SSCI), Scopus
  • Page Numbers: pp.1294-1311
  • Keywords: effectiveness, performance measurement, access to health services, utilisation of health services, outcome measures in health, quality, PERFORMANCE-MEASUREMENT, ORGANIZATIONAL PERFORMANCE, PATIENT SATISFACTION, DEVELOPING-COUNTRIES, HOSPITAL EFFICIENCY, SYSTEM PERFORMANCE, MANAGEMENT, IMPACT, ACCREDITATION, DETERMINANTS
  • Hacettepe University Affiliated: Yes


Healthcare institutions face significant challenges in implementing quality initiatives such as performance measurement. In the wake of multiple studies emphasising deficiencies in performance measurement in healthcare, measuring the performance of healthcare services to improve quality takes a great attention in the literature. Understanding the relationships between performance indicators is a first step for this. Effectiveness, which is one of the performance indicators in healthcare, reflects the effect of health interventions on health outcomes. Accessibility of services and utilisation are the two main dimensions of this concept. These indicators have the potential for improving outcomes, performance, and quality in health. This study explores the relationship between effectiveness and health outcome indicators as they relate to the development level and geographic region of 81 provinces in Turkey using a path analytic model. The numbers of hospitals and physicians are used as indicators of accessibility of healthcare services, while the average length of stay and number of surgical operations are used as indicators of utilisation. Life expectancy and general satisfaction from healthcare services are determined as outcome measures. According to the final path model, a strong relationship exists between accessibility indicators and health outcomes. A strong relationship was also found between life expectancy and general satisfaction with healthcare services, which are the objective and subjective outcome measures in healthcare, respectively. These results help our understanding of the relationship among key performance measures to improve health systems performance and quality.