158-980 / Hospital performance assessment framework based on citizens engagement

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Agenas- Italian National Agency for Regional Healthcare Services


Patient surveys
Patient empowerment
Patient safety culture / Patient safety climate
Patient involvement
GOP Description
Implementation level
Clinical settings
Acute care facilities, both public and private, throughout the country.
To carry out a nationwide survey on the quality of hospital care with the aim of contributing to the development of a National system for the assessment of healthcare quality with particular regard to the macro-criterion of empowerment (acceptable and equitable quality dimensions).
Healthcare organizations and professionals, citizens
The GOP methodology is based on the widest possible involvement of stakeholders. The first step consisted of the setting up of a group of National experts in the field of service assessment from of professionals citizens perspective. All the Italian Regions/ Autonomous Provinces (APs) and the ActiveCitizenship Network (a national civic organization), took part in the development of shared methods and tools for assessment and improvement of patient centeredness in hospital. Every methodological step – definition, testing and validation of checklist, shared survey procedure – were carried out involving the stakeholders, with particular reference to citizens organizations at regional and local level (54 hospitals, belonging to 16 Italian Regions, 111 citizens). The assessment tool (checklist) was developed taking into account evidence from literature, national and international good practices, paying particular attention to procedures and indicators scientifically validated. The most important element of this methodology is the shared process, which provides for the mandatory involvement of citizens: as a matter of facts, it is a mixed group (local équipe)- made up by healthcare workers and citizens- who expresses the level of patient centeredness of each hospital. This group gives a shared opinion on each item of the checklist.
Timeframe implementation
18 months
Implementation tools available
The checklist consists of 144 items, with multiple choice answers. The items explore the four main areas the concept of patient-centeredness was divided into:
1.    Person-oriented organizational and care processes (divided into 4 sub-areas, made up by 10 criteria, explored through 49 items);
2.    Physical accessibility livability and comfort of care premises (4 sub-areas, 9 criteria,47 items);
3.    Access to information, streamlining and transparency (2 sub-areas, 5 criteria, 21 items);
4.    Taking care of the relationship with patients/citizens ( 2 sub-areas, 5 criteria, 27 items).
In order to guarantee a uniform interpretation, every item has an explanatory note.
A dedicated website was created for data provision.
Implementation cost
130.000,00 €
Method used to measure the results
A scoring system for every item was defined, on a range going from 0 to 10; the option “NOT APPLICABLE” is not included in the calculation; the answer “DATA NOT AVAILABLE” was given a score of 0. For questions which included entering a ratio, it was calculated the ratio and then rounded up to the nearest integer. A weighting system is being studied based on the ranking technique, which will allow to define relevance of criteria and items. As per results, the average scores and the variance were calculated for every item of the area and for the area itself.
Testing phase. Below are the scores achieved by the 54 hospitals assessed.
1. Person-oriented organizational and care processes: 6,39
2. Physical accessibility, livability and comfort of care facilities: 7,12
3. Access to information, streamlining and transparency: 6,71
4. Taking care of the relationship with the patient/citizen: 6,89
Data collection phase
It is still ongoing. Therefore, below are the project outputs:
• Participation of all the Italian Regions and Autonomous Provinces;
• Participation to data collection of 245 healthcare organizations throughout the country (217 public e 28 private accredited);
• Training on the use of the checklist for shared quality assessment of about 500 citizens and an equal number of professionalsExpected Impact: results have no impact at present on hospital level of financing. The national survey on the quality of hospital care is aimed at contributing to the creation of a National System for the assessment of healthcare quality. Once the national system will be settled, in agreement with the Ministry of Health and the Regions, the possibility that it could be also useful for determining hospital funding, particularly in the context of accreditation programs, will be considered. It is a possibility that, once the results will be published, these could address the choice of citizens among hospitals thus indirectly influencing the financing mechanisms.The results of the survey are aimed at influencing the clinical and organizational practices. The local team – made up by healthcare professionals and citizens- who expresses the level of patient centeredness of each hospital, identifies critical issues on the basis of collected data and suggests corrective actions. Corrective actions are proposed to the hospital management which can use them to implement an improvement plan to be monitored in collaboration with both the local team and community.
Analysis of the results
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
Participation to data collection was on a voluntary basis, that is to say that the 21 Regions/APs decided independently, according to their history, experience and political-economic-administrative conditions.
(In Italy Healthcare system is decentralized and it is the Regional government who is responsible for organizing healthcare).
Describe the strategies used to overcome the barriers (If needed)
Sharing critical issues, goals, actions and tools with all the stakeholders.
Take into account and build upon the experience gained by Regions.
Other information
Other information about the GOP that you would like to add (Link or attached document)