National Quality Indicator
National Quality Indicators in healthcare are standardized, evidence-based measures of health care quality that can be used with supportive administrative data to measure and track clinical performance and outcomes.
In the domain of healthcare, good quality services 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 services, and the health authorities. It is important that patients have information about quality in the health service and that the health service uses this in their improvement work.
National Quality Indicators are based on one or more of the dimensions of quality listed above and can, for example, measure the health service's available resources, the patient course, and the result of the health services for the patients. 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 a sound quantitative basis for prioritisation and management.
- Provide owners and managers at all levels of the health and care services 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 the health care 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 process, e.g., diagnostics, treatment)
- Performance indicators (survival, health gain, patient and user satisfaction, etc.)
The National Quality Indicator System in Norway
The National Health Care 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 trust (RHF), health trust (HF), and hospital / county municipal levels on the Norwegian Directorate of Health website.
The National Quality Indicator system currently comprises of more than 180 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. The majority of indicators focus on processes in specialist health service. New indicators are constantly under development, with currently a high emphasis on primary health care including municipal health and care services, emergency medical 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, the local contexts will always be factors which can affect comparability. Hospitals may have national roles in treatment of specific diseases and thereby have larger patient population 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 for the National Quality Indicator System. However, there might be missing data which affect interpretation in aggregated data.
- Due to privacy rules in statistical legislation, data cannot identify neither patients nor health personnel on an individual level. Small municipalities and hospitals with a small population for specific indicators can be affected, and results may not be published for one or more hospitals/municipalities.
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