The PATH project in eight European countries: an evaluation.

PURPOSE: This paper's aim is to evaluate the perceived impact and the enabling factors and barriers experienced by hospital staff participating in an international hospital performance measurement project focused on internal quality improvement. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews involving international hospital performance measurement project coordinators, including 140 hospitals from eight European countries (Belgium, Estonia, France, Germany, Hungary, Poland, Slovakia and Slovenia). Inductively analyzing the interview transcripts was carried out using the grounded theory approach. FINDINGS: Even when public reporting is absent, the project was perceived as having stimulated performance measurement and quality improvement initiatives in participating hospitals. Attention should be paid to leadership/ownership, context, content (project intrinsic features) and processes supporting elements. RESEARCH LIMITATIONS/IMPLICATIONS: Generalizing the findings is limited by the study's small sample size. Possible implications for the WHO European Regional Office and for participating hospitals would be to assess hospital preparedness to participate in the PATH project, depending on context, process and structural elements; and enhance performance and practice benchmarking through suggested approaches. ORIGINALITY/VALUE: This research gathered rich and unique material related to an international performance measurement project. It derived actionable findings.

Health system stewardship of National Health Ministries in the WHO European region: concepts, functions and assessment framework.

OBJECTIVES: To propose an operational framework for assessing the completeness and consistency of the stewardship function of national health ministries. METHODS: The authors carried out a purposive and multidisciplinary review of the literature and derived an operational framework through iterative discussions and participatory methods. The results of the literature review were compared to the authors' observations of stewardship in action and key functions were matched with case examples from Europe and North America. RESULTS: The operational framework relates six functions of stewardship with national contexts, values and ultimate goals pursued by health systems: to define the vision for health and strategy to achieve better health; to exert influence across all sectors for better health; to govern the health system in a way that is consistent with prevailing values; to ensure that system design is aligned with health system goals; to better leverage available legal and regulatory instruments; and to compile, disseminate and apply intelligence. CONCLUSIONS: Challenges in the implementation of stewardship relate to: limitations to the role of health ministries; and to governance, operational and change implementation issues. The framework proposed seems flexible enough to help assess the health system stewardship function; however it should be further tested in practice.