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Abstract
Objective This study aims to advance understanding of globally valid versus country-specific quality dimensions and indicators, as perceived by relevant stakeholders. It specifically addresses patient-level indicators for cataract surgery.
Design A mixed-methods case study comparing Singapore and The Netherlands
Setting Singapore (2017–2019) and The Netherlands (2014–2015).
Participants Stakeholder representatives of cataract care in Singapore and The Netherlands.
Intervention Based on the previously identified complete set of stakeholders in The Netherlands, we identified stakeholders of cataract care in Singapore. Stakeholder representatives then established a multi-stakeholder perspective on the quality of cataract care using a concept mapping approach. This yielded a multidimensional cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined during a plenary session. Thereafter, Singaporean dimensions were matched with dimensions obtained in The Netherlands to identify commonalities and differences.
Main outcome measure Health-services quality dimensions of cataract care.
Results 19 Singaporean stakeholders representing patients, general practitioners, ophthalmologists, nurses, care providers, researchers and clinical auditors defined health-services quality of cataract care using the following eight dimensions: clinical outcome, patient outcomes, surgical process, surgical safety, patient experience, access, cost and standards of care. Compared with the Dutch results, 61% of the indicators were allocated to dimensions of comparable names and compositions. Considerable differences also existed in the composition of some dimensions and the importance attached to indicators.
Conclusions and relevance This study on cataract care in Singapore and The Netherlands shows that cataract care quality measurement instruments can share a common international core. At the same time, it emphasises the importance of taking a country-specific multi-stakeholder approach to quality definition and measurement. Complementing an international core set with country-specific measures is required to ensure that the included dimensions and indicators adequately capture the country-specific quality views.
- health policy
- international health services
- quality in health care
- cataract and refractive surgery
Data availability statement
Data are available upon reasonable request. The data from the concept map respondents are stored in the concept mapping software and can only be accessed with the password of the authors. The authors are available to provide such access if requested. All subsequent data are included in the supplementary materials.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. The data from the concept map respondents are stored in the concept mapping software and can only be accessed with the password of the authors. The authors are available to provide such access if requested. All subsequent data are included in the supplementary materials.
Supplementary materials
Supplementary Data
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Footnotes
Contributors AS-V co-designed the research, collected the data, analysed the data and was in the lead of the writing. DDK conceptualised the research, coordinated the data collection in Singapore and contributed to the introduction and discussion section. EL contributed to the data collection in Singapore, and contributed to the introduction and discussion section. CW facilitated the data collection in Singapore, and contributed to the introduction and discussion section. JJVB conceptualised the research, coordinated the data collection in The Netherlands, initiated the data collection in Singapore, supervised parts of the data analysis and critically reviewed the manuscript. JJvdK supervised the research, supervised parts of the data analysis and co-wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement statement Representatives from Patient Organisations and Patients who volunteered to take part in the research provided quantitative and qualitative input to represent the view of the stakeholder patient. They also took part in the stakeholder group discussion in which results were interpreted and consensus on quality dimensions was reached. Both in Singapore and in The Netherlands the patient respondents have approved the national results.
Provenance and peer review Not commissioned; externally peer reviewed.
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