National Quality Indicators
National Quality Indicators in healthcare are standardized, evidence-based, and indirect measures of healthcare quality that can be used with supportive administrative data to evaluate and track clinical performance and outcomes.
In the domain of healthcare, services of good quality are generally defined as services that are:
- Effective
- Safe and secure
- Patient-centred
- Coordinated and characterized by continuity
- Utilizes resources
- Available and fairly distributed
Transparency about healthcare performances and outcomes is important for all involved parties - patients and their relatives, health service providers, and the health authorities. It is important that patients have information about the quality of healthcare services and that the health service providers use this for quality improvement.
National Quality Indicators are based on one or several of the dimensions of quality listed above and may, for example, measure the availability of resources in healthcare services, patient pathways, and patient outcomes linked to healthcare services. Quality indicators should always be seen in context with other relevant information and statistics for a holistic view of the quality of the associated service.
Quality indicators can be a tool for improving patient safety, service quality and the implementation of national guidelines.
The National Health Care Quality Indicators serve several purposes. They are intended to:
- Provide central health authorities with a sound quantitative basis for prioritisation and management.
- Provide owners and managers at all levels of the healthcare services with a basis for using the results for local quality improvement.
- Give patients, users, and relatives the opportunity to make choices based on precise information.
- Contribute to transparency regarding quality and variation in healthcare services.
The National Quality Indicators are generally divided into three main types of quality measures:
- Structure indicators (frameworks and resources, competence, available equipment, registers, etc.)
- Process indicators (activities in the patient pathways, e.g., diagnostics, treatment)
- Outcome indicators (survival, health gain, patient and user satisfaction, etc.)
The National Quality Indicator System in Norway
The National Healthcare Quality Indicator System is intended to help secure the population equal access to high-quality healthcare, and is based on the framework for the OECD's Health Care Quality and Outcomes program (European Observatory on Health Systems and Policies 2021)
The Norwegian Directorate of Health is responsible for developing new indicators, maintaining, and publishing them in accordance with a predefined schedule, depending on the availability of new data. The indicators are usually published three times a year and/or annually. Results are published at a national level, per Regional Health Authority (RHA/RHF), health trust (HT/HF), and hospital/county municipal levels on the Norwegian Directorate of Health website.
The National Quality Indicator System currently comprises approximately 150 indicators, from approximately 20 different data sources. Indicators are developed and produced in cooperation with analysts and experts on national and regional health surveys, central health registries, and medical quality registries. Most indicators focus on processes within the specialist health service. New indicators are under constant development, with a strong current focus on primary healthcare, including municipal healthcare services, mental healthcare services, and services provided by general practitioners.
Interpret with caution
When interpreting the data, it is important to be aware of some thumb rules in statistics:
- Statistics aim to be comparable over time and between regions. However, local contexts will always be factors that can affect comparability. Hospitals may have national roles in the treatment of specific diseases, resulting in larger patient populations and a need for specialized personnel. Municipalities often differ in demographic structures and rural/urban prerequisites.
- A high degree of data quality and coverage is required for registers supplying data to the National Quality Indicator System. However, there might be missing data that affect the interpretation of aggregated data.
- Due to privacy rules in statistical legislation, data can neither identify patients nor health personnel on an individual level. This means that, for small municipalities and hospitals with limited populations, results may not be published.
More information on National Quality Indicators in Norwegian
Useful links
- Health Registries at the Norwegian Institute of Public Health (fhi.no)
- The Norwegian Healthcare Atlases
The Norwegian Healthcare Atlas compares the population's use of health services using interactive maps, reports, and fact sheets. - Statistics Norway (ssb.no)
- Health Policies and Data from OECD