As long as we can’t compare hospital quality, we should at least know how often treatments are being performed, writes Barend van Lieshout

Assessing the quality of hospitals is not easy. After years of hard work the quality of only a handful of treatments can now be compared. The subsequent standards require a minimal number of treatments. Meanwhile patients are being told the size of the hospital is not important, that there is no proof that big hospitals are better than small ones. As long as the sector doesn’t set quality standards for treatments, hospitals should publish their production volumes. The patient will then be in a position to decide for himself if scale matters or not.

Only last week professor of clinical epidemiology Yolanda van der Graaf concluded that quality assessment of hospitals has a very long way to go. There are a few frontrunners, like the registration of colon cancer treatments, but they are the exceptions that prove the rule. 

Part of the challenge is that it’s not relevant to the patient if the hospital concerned has a good name generally, or if its specialism is well-regarded. The main question for the patient is whether the hospital has a team that can perform the specific treatment that will make him better.

Routine

No matter how big and intimidating the hospital buildings may look, the number of individual treatments is small. Most treatments, especially the complex ones, will not occur more than a few dozen times a year. And they are divided among several specialists. Moreover, patients differ significantly in age, weight, health, etc. Is this conducive to building up a routine? Is it possible to stay abreast of the latest medical developments?

The conclusion that bigger volumes lead to quality is a plausible one. The quality standards set by specialists invariably mention a minimum volume. At the same time, the medical profession and even patients’ associations are making reassuring noises: there is no proof that smaller hospitals provide sub-standard care.

Interest

Insurers, specialists and the government have a vested interest in preventing a run on the large hospitals. Smaller hospitals would go under and that would harm the accident & emergency infrastructure.

Individual patients have no such interest. Those with good contacts in the medical world will know that when a family member or friend falls ill with a serious medical problem no time is lost in finding the right clinic and the best specialist. The rest of the country will have to make do with lists in the AD or Elsevier which are really no more than clever marketing gimmicks for hospitals.

That is not altogether fair. It’s also rather paternalistic to state that patients shouldn’t take treatment volumes into account. The fact that it will take several decades before we have comprehensive quality assessment data should prompt hospitals to reveal their treatment volumes. The good news is that this won’t require any extra effort as far as registration is concerned. All it takes is the publication of the annual declaration mix, the interpretation of which can be safely left to the numberless comparison sites already in existence.

Barend van Lieshout is a healthcare advisor at Rebel