Improving quality of care through public subnational reporting in Sweden
The National Board of Health and Welfare is responsible for the transparent publishing of indicator-based evaluations of compliance with national guidelines and subnational comparisons of quality and efficiency of health care in Sweden.
For nearly 10 years Sweden has produced reports on health care, public health and social care, and made them available in the public domain in order to improve performance. Subnational comparisons are made in cooperation with the Swedish Association of Local Authorities and Regions; they are updated and published annually.
In Sweden, counties and municipalities are responsible for financing and managing health care and social services. Conditions that have been crucial for the development of public reporting include use of a personal identification number for each patient in every registry and access to data: both to mandatory health data and social data registries and to non-mandatory, professionally developed registries on quality of care.
These quality of care registries have received substantial funding from the government over the last few years, increasing their utilization.
Key success factors
Thus far the public reporting efforts have been successful. Quality and improvement are on the health agenda, and the results measured by the indicators have improved over time. Several key success factors have been identified, including:
- trust between the actors;
- acceptance of the reported outcomes by professionals;
- awareness that establishing such a reporting cycle is a complex and time consuming task;
- focusing on quality, guidelines, evidence-based medicine, equity and improvement of work rather than financial incentives;
- involvement and acceptance by counties and municipalities;
- local organizations' use of data to start improvement work.
Public reporting demands extensive communication and networking to create trust and acceptance. A focus on quality issues, improvement efforts and access to data is important, while use of indicators for financial incentives is not recommended.
The counties, municipalities and local caregivers need to be involved and have knowledge about improvement techniques and data utilization to implement improvement initiatives. Public reporting is one of many useful tools to improve health information; it should be combined with other tools such as qualitative methods.