Quality of performance in the hospitals in Belgrade

Numerous research papers in the world have shown significant variations among the countries (and regions within them) in respect to provision of health care for same diseases and conditions. This influenced development of a number of activities aimed at detection and promotion of quality of health care. Ministry of Health of Serbia has defined improvement of quality of the national system of health care as one of its health policy priorities. Since 2004, the Ministry has been carried out activities in order to monitor, provide and promote quality of health care. The aim of our paper is to estimate the quality of performance of hospitals of the city, based on defined indicators. Reports on performance quality for hospitals in the capital, for the periods between January 1 - June 30, 2005 and July 1- December 31, 2005 were used as the source of data. The results have shown significant differences among the hospitals. Hospital lethality rate (myocardial infarction) ranged from 10.5% in Clinical Hospital "Zvezdara" to 15% in Clinical Hospital "Dragisa Misovic". Lethality rate for cerebral- vascular insult was found to be 20% in Clinical Hospital "Zvezdara"; 23% in Clinical Hospital "Zemun" and 26.4% in Specialized Hospital B. "Sveti Sava". Average number of surgeries in general anesthesia per surgeon per year was found to be 99; ranging from 26 in "Banjica" Institute to 244 in Hospital for Obstetrics and Gynecology "Narodni front". In Institute for cardio- vascular diseases "Dedinje" a surgeon performs 10.85 interventions per month; in Institute for CVD within the Serbian Clinical Center- 5.92 surgeries per surgeon per month. Average length of pre- operative stay in the Belgrade hospitals in 2005 was 2.87 days. In a majority of facilities, it is about 2 days. Longer pre- operative stay was recorded in the University Children’s Hospital (3.2 days), Clinical Center of Serbia (3.5), Institute for cardio- vascular diseases "Dedinje" (4.7) and Institute "Banjica" (6 days). Average length of hospital treatment significantly differs among facilities: it is 3 days longer in Orthopedic Hospital within Clinical Center of Serbia than in Institute "Banjica". In Children’s Clinic (Surgery) within University Children’s Hospital it is 2 days longer than in Serbian Institute for Mother and Child Health. In relation to the number of nurses per one hospital bed, Clinical Hospitals "Bezanijska kosa" and "Zvezdara" have significantly greater numbers of nurses per one bed than the remaining two clinical hospitals. The same applies to Hospital for Obstetrics and Gynecology "Narodni front" in relation to the facilities for obstetrics and gynecology within the Serbian Clinical Center. Differences in the values of indicators of quality among the facilities for health care in the city may point to differences in the quality of hospital care. However, they might be caused by the factors not related to the quality of care (such as data quality, characteristics of patients and of the facilities). That is the reason why it is necessary to promote the very indicators of quality and define standards or national average for the tertiary level of care. This would enable comparisons of similar facilities. Besides the listed limitations, indicators of quality do have a significant role in pointing to the differences among facilities themselves. It is necessary to have further investigations in this area. .