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Distance to hospital / clinic
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Measured as air-line distance in km between the hospital and the city you chose (e.g. zip code, city center).
Strengths:
The distance is a good indicator for the accessibility of the hospital for you and your relatives. This is not a universal quality indicator, but shows your personal best hospitals based on accessibility.
Limits:
Travel times with public and private transport may differ. Obstacles (such as lakes or mountains) and ways of transport (highways, streets, train) were not considered.
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Total patient numbers
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Measured as number of discharges per calendar year.
Strengths:
The total number of patients is an objective and reliable indicator of the size of the hospital and therefore a good proxy for the experience a hospital has with disease patterns, diagnosis and therapy. In case your disease is rare, this is of particular importance. Additionally, a bigger hospital usually has more extensive technical equipment.
Limits:
Also in large hospitals there is no guarantee that there is a lot of experience with a particular disease. Knowledgeable stakeholders changing jobs and leaving the hospital for example can lead to a loss of such expertise. Please also be careful with the inverse conclusion: smaller hospitals can by all means be specialized in a specific therapeutic area and reach high patient numbers and expert knowledge. If available, it is therefore preferable you rely on specific patient numbers.
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Specific patient numbers
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Number of patients with a specific diagnosis or intervention (per calendar year).
Strengths:
High patient numbers with a specific diagnosis or intervention is a indicator for good knowledge and expertise. A hospital with high specific patient numbers has a lot of experience with different techniques of diagnosis and treatment (e.g. surgeries). Additionally, high specific patient numbers suggest that employees and technical equipment are up to date.
Limits:
Unfortunately, specific patient numbers are not available for all interventions. It is not sure that results are transferable to similar interventions. Also, the relationship between patient numbers and experience/competency is not linear. Especially with very high specific patient numbers the expertise and knowledge does not increase in equal measure.
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Infection rates
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Measured as the ratio of expected and observed numbers of infections after certain types of surgery.
Strengths:
Infections are risky and associated with more distress. A low infection rate is an indicator of good hygiene and a high quality treatment process. The infection rates are risk adjusted by Swissnoso using three additional measurements. This elaborate form of risk adjustment fulfills high scientific standards.
Limits:
Unfortunately, infection rates are not available for all interventions. It is not sure that results are transferable to similar interventions. Also, infection rates are only meaningful when a sufficient number of cases is reached. Especially with interventions with a low risk of infections the needed number of cases is very high and is only reached by large hospitals. For small hospitals it is often not possible to give a meaningful statement (while small case numbers are per se unfavorable, especially with complex interventions).
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Re-operation rates
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Mesuré en tant que taux de réopération ajusté au risque pour les premières implantations d'endoprothèses (hanche artificielle, genou artificiel) dans les deux ans - par hôpital.
Strengths:
Re-operations after the insertion of prostheses are risky for patients and are associated with additional suffering. A low re-operation rate provides a reliable indications of optimal surgical techniques and procedures, the use of the best possible prosthesis products, and high-quality follow-up care.
The re-operation rates (implant register) are risk-adjusted by the Foundation for Quality Assurance in Implant Medicine SIRIS with various additional measurements (age and gender, BMI, ASA-Sore and Charnley classification). This elaborate form of risk adjustment meets high scientific standards.
Limits:
Re-operation rates are only meaningful when a hospital has a sufficient number of cases. In the case of small hospitals, nothing can be said with certainty (whereby small case numbers are considered unfavourable in terms of good quality anyway). In order to achieve statistically sufficient case numbers, observations are made over two years. This means that the figures are already two to four years old when they are published. It is therefore possible that a hospital that performs poorly could have its quality improved in the meantime and vice versa.
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Mortality rate
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Relative proportion of deaths in hospital for a specific intervention or disease per hospital.
The hospitals sometimes treat groups of patients with different case severity. Therefore, the FOPH determines a rate of expected deaths per hospital and procedure. For the quality comparison, we use the ratio between the expected and the actually observed deaths (per intervention and per hospital). This is called risk adjustment. For this reason, it can occasionally happen that a hospital performs better in the ranking even though it has a slightly higher percentage of deaths.
Please note that we use the FOPH data per hospital site in order to achieve the most precise statements possible.
Strengths:
A low number of deaths is the main aim of each treatment and therefore a crucial indicator for patients. A low mortality rate is an indicator of effectively avoiding complications and good treatment processes in the hospital (e.g. quality of surgical techniques, avoidance of errors and complications etc)
Limits:
Unfortunately, mortality rates are not available for all interventions. It is not sure that results are transferable to similar interventions. Also, mortality rates are only meaningful when a sufficient number of cases is reached. Especially with interventions with a low risk of death the needed number of cases is very high and is only reached by large hospitals. For small hospitals it is often not possible to give a meaningful statement (while small case numbers are per se unfavorable, especially with complex interventions). Mortality rates are risk adjusted by the BAG by age and gender of the patient (for details please see the corresponding publications by BAG). A number of specialists have criticized this form of risk adjustment as inadequate. Also it needs to be noted that differences in patterns of relocating patients can introduce bias to mortality rates.
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Readmissions (relapses)
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Since 2018, the
ANQ has been publishing data on the frequency of rehospitalizations - unfortunately, however, only for hospitals in the acute care sector. In 2021, he improved the methodology and now refers to the key figure as "unplanned rehospitalisations". This indicator shows how often patients have to return to hospital after a hospital stay.
What is an "unplanned hospital readmission"?
An "unplanned hospital readmission" occurs when a patient has to be readmitted to hospital within one month of a hospital stay for the same health problem. This can be an indication that the treatment was not sustainable and that the health problems have recurred.
Why is a low readmission rate important?
A hospital stay is stressful for patients and can be associated with high costs. A low readmission rate means that the treatment in the hospital was successful and that patients recover more quickly.
What are the reasons for a low readmission rate?
- Good and sufficiently long treatment in hospital: The treatment in hospital should be tailored to the individual needs of the patients and should last long enough.
- Careful planning of subsequent outpatient care: After the hospital stay, it is important that patients continue to receive good care. This can be provided by Spitex, family doctors or other specialists.
- Good information for patients: Patients should be well informed about follow-up treatment and measures to promote healing.
- Adequate reports to follow-up care providers: The treating doctors in the hospital should provide the follow-up care providers (e.g. family doctors) with all important information about the treatment and the patient's health status and upload the treatment-relevant documents to the patient's EPR.
Strengths:
- Measuring unplanned readmissions highlights many important quality issues in healthcare.
- The methodology is well thought-out and excludes diseases or circumstances where readmissions are inevitable or very likely.
- The data is risk-adjusted, i.e. it takes into account that different patient groups have different risks of readmission.
- The data comes from the Federal Office of Public Health's routine medical statistics and covers almost all cases in Swiss hospitals.
Limits:
- Even with optimal treatment and aftercare, a certain number of relapses and readmissions are to be expected.
- Risk adjustment is subject to certain uncertainties.
- It is questionable whether large differences in the patient population (e.g. between a private clinic and a university hospital) can be fully compensated for by risk adjustment.
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Patient satisfaction
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Patient satisfaction is an important measure of hospital quality. It primarily reflects the patients' perception of the quality of treatment, the medical result and the competence and friendliness of the staff. In addition, when comfort elements such as good food and beautiful spaces surpass patients' expectations, excellent ratings are achieved. However, good comfort factors alone (without good medical quality) do not lead to high ratings.
Patient satisfaction is measured by ANQ (National group for quality development in Swiss hospitals and clinics) via a standardized questionnaire. These measurements may be considered the most reliable and comprehensive in Switzerland. The patients are each asked six questions after hospital discharge (multiple choice). We use the answers to the most general question about the quality of hospital treatment. In paediatrics, similar questions are used to query the satisfaction of the parents. The ANQ evaluations include a risk adjustment to make the hospitals comparable.
Strengths:
Patient satisfaction shows the view of the customer. It is therefore the most direct, honest and only holistic measurement. Patient satisfaction increases with good medical and nursing care and also reflects the quality of communication and the "atmosphere".
Limits:
Not all patients fill in the questionnaires; a low response rate results in uncertainty whether the non-responders would probably think differently.
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Patient satisfaction - free text
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As per free text field on the website.
Visitors of the website are asked to share the experience they made with a certain hospital. Thereby also free text answers can be given. All of these are being validated for formal correctness before clearance.
Strengths:
Free-text answers show, in contrast to quality indicators, a much more comprehensive and true-to-life picture of a hospital. They allow to pass potentially crucial information which is not captured in structured questions.
Limits:
Free-text answers are strongly influenced by the personal experience in the particular case. We therefore ask you to critically judge whether the described experiences are generally applicable and could be relevant to your case. Also, with surveys via the internet, fraudulent manipulation cannot be fully excluded. To limit this hazard, we identify and block serial entries. Additionally, we have introduced a verification system via mobile phone number. Using this system, manipulations can largely be excluded. Validated and non-validated entries are being marked as such when they are displayed on the website.
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Number of employees
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Measured as the number of employees (doctors incl. affiliated doctors, nurses) per (100% occupied) bed in a hospital.
Strengths:
The number of employees (physicians, nurses) can be captured objectively and precisely and is a good indicator for the intensity of medical/nursing care at the hospital.
Limits:
Some confounding factors are possible, e.g. a high number of researchers, or different ways of counting part-time workers.
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Treatment outcome psychiatry
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Measured as reduction of symptom load between admission and discharge. The two measurements are done by both the therapists and the patients, resulting in two values: The outcome from the perspective of the therapists (external assessement) and the patients (self assessement).
The result are risk adjusted by the ANQ (National group for quality development in Swiss hospitals and clinics) and thus made comparable.
Strengths:
The methodics were developed by the ANQ in collaboration with experts and the psychiatric clinics, thus are broadly supported. Internationally well accepted measuring instruments are being used: The Health of the Nation Outcome Scale (HoNOS) for the measurement by the therapists and the Brief Symptom Checklist (BSCL) for the self-assessement by the patients. The analysis is performed by a renowned reasearch institute.
Limits:
The methods of the measurements and the risk-adjustment have been critically questioned: It is not proven, that good results at the time of discharge are sustainable. It was argued that there are little means to control possible data manipulation. Other experts doubt the risk-adjustment process. In the self-assessement, low response rates can compromize validity. Furthermore it has been assumed, that some psychiatric patients might not be capable of assessing their own condition appropriately.
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Rate of compulsory hospitalizations (Psychiatry only)
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Ratio between the number of compulsory admitted patients and total number of patients.
The data is claimed by the ANQ (Nationaler Verein für Qualitätsentwicklung in Spitälern und Kliniken) according to the specifications of the Bundesamt für Statistik.
Strengths:
The rate of compulsory admitted patients is no quality indicator in the narrower sense. However a low rate gives a good clue for a more quiet treatment ambience.
Limits:
Clinics with a stately mandate of general psychiatry usually have a higher rate of compulsory hospitalizations. The rate is also determined by the admitting practitioners, the laws and the authorities.
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Rate of privately insured patients (Psychiatry)
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Ratio between the number of privately insured patients and total number of patients.
The data is claimed by the ANQ (Nationaler Verein für Qualitätsentwicklung in Spitälern und Kliniken) according to the specifications of the Bundesamt für Statistik.
Specialized clinics for addiction normally have no privately insured patients as private insurance policies usually exclude this diagnosis.
Strengths:
The rate of privately insured patients is no quality indicator in the narrower sense, but a higher value gives a good clue for a more quiet treatment ambience and a higher level of comfort.
Limits:
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Hospital-bedsore
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Since 2011, the National Association for the Development of Quality in Hospitals and Clinics (ANQ) assesses the prevalence of hospital-acquired bedsores in the majority of Swiss hospitals and in some rehab-clinics. A bedsore (pressure sores, pressure ulcers, decubitus) is defined as a lesion of the skin and, if progressing, also of the deeper tissue caused by prolonged pressure. Bedridden and wheelchair-bound people are vulnerable. Hips, buttocks and heels are particularly at risk. A bedsore is often chronic and makes the patient prone to infections, which can lead to sepsis in severe cases.
Bedsores are often a result of insufficient care. Their prevention requires appropriate measures e.g. avoidance of dents, frequent turning and repositioning, use of anti-decubitus mattresses and cushions, controlling heat and moisture levels of the skin surface. Thus bedsores can frequently be avoided with attentive and well-organized care. The rate of hospital-acquired bedsores is therefore a good measure of the thoroughness of hospital-care.
Strengths:
The hospitals have been assessing the prevalence of bedsores since many years, so the methods are well established. The number of included patients per hospital is generally sufficient to make the results reliable.
Limits:
The risk for bedsores strongly depends on concomitant diseases and other factors (e.g. age, paralysis, circulatory disorders and diabetes). Adjusting the data from such disturbance variables is challenging and can be a source of errors. Moreover, the reliability of the results depends on the thorough recording of symptoms by the hospital staff.
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Birth, result quality
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The independent association Hospital Comparison Switzerland carries out a national survey of self-employed midwives on the outcome quality concerning inpatient births. Good outcome quality is understood as the the absence of avoidable complications and a high satisfaction of the mothers with the hospital, clinic or birthplace. The midwives provide their experience and their expert knowledge with their feedbacks for a public use. In particular, expectant mothers can benefit from these evaluations as a help for choosing a hospital, a clinic or a birthplace.
Strengths:
The midwives accompany the (expectant) mothers generally from early pregnancy to some time after birth. They conduct detailed discussions with the young mothers and thus learn a lot about the medical circumstances and the course of the birth and the care in the hospital / clinic. Due to their in-depth knowledge and wide experience horizons, they can distinguish unavoidable complications from treatment deficiencies. Midwives come into contact with many health care providers. They are thus able to observe and compare many births in different hospitals / clinics.
Limits:
It is possible that some vested interests of the self-employed midwives may lead to a certain bias in favor of the birthplaces. However, this is neutralized by the separate analysis of the birthplaces: We compare the birthplaces only with one another and not with the hospitals and clinics.
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Hip replacement, result quality
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The independent association Hospital Comparison Switzerland performed a national survey of qualified physiotherapists with regard to the outcome quality in hip replacement surgery. Good outcome quality is defined as a rapid, significant and sustained functional improvement, the absence of avoidable complications and a high patient satisfaction with the hospital or clinic. With their feedback the physiotherapists provide their experience and expert knowledge to the public. Patients can benefit from this survey as a help for choosing a hospital or a clinic.
Strengths:
Physiotherapists often accompany patients with hip problems in different stages of their disease and also after surgery. They get particularly involved in case of complications or a delayed recovery, lead detailed discussions with the patients and thus learn a lot about the medical circumstances, the course of the surgery and the level of care in the hospital / clinic. Due to their in-depth knowledge and wide experience, physiotherapists can distinguish unavoidable complications from treatment deficiencies. Physiotherapists are in contact with many different health care providers and are thus able to observe and compare many hip replacements in different hospitals / clinics. Often being self-employed warrants the independence of their opinion.
Limits:
A poll on a voluntary basis will never be answered by all respondents, creating uncertainty about the representativeness of the sample. Part of the non-answering physiotherapist focus on other disciplines (such as pediatric physiotherapy or neurological rehabilitation) and therefore have little experience with hip replacement patients. Some physiotherapists are also employed in hospitals and clinics and thus, at best, they may have a conflict of interests.
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Treatment outcome rehabilitation
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Treatment outcome (outcome quality) in inpatient rehabilitation is measured and evaluated differently depending on the rehabilitation area. The results of the treatment outcome (outcome quality) are risk-adjusted by the ANQ (National Association for Quality Development in Hospitals and Clinics) and thus made comparable. Before publication, they are discussed with the participating clinics.
Strengths:
The measurements by the ANQ have been developed and optimized over several years in cooperation with experts and the involved clinics and are thus well supported. Internationally recognized instruments are used. The evaluation is carried out by recognized research institutes.
Limits:
Rarely, the applied methodology has been criticized, and whether the risk adjustment carried out by the ANQ appropriately reflects the clinic-specific patient mix.
