Authors
Abstract
BACKGROUND: Hospitals in developed countries allocate itself about 40% of health‑care costs
and in developing countries up to 80%. In this study, researchers reviewed the related article in the
field of the hospitals’ performance evaluation due to the identification of common indicators used
in different models with the aim of providing simple list for evaluating hospitals’ performance to the
researchers who are interested to these issues.
METHODS: The databases for the search included Medline, Google Scholar, and Scopus. A search
strategy leads to the extraction of 403 related articles that after the removal of inappropriate and
duplicate articles, 42 studies were selected for the scoping review.
RESULTS: This scoping review showed that 9 of 42 selected articles use data envelopment analysis
model, 6 of them Pabon Lasso model, 3 of them balanced scorecard, 3 of them organizational
excellence model, and the remaining articles used key performance indicators to evaluate hospital
performance. A process approach was used to categorize the common indicators because the
literature review indicated that common indicators mainly evaluate data, process, output, or impact of
performance. The findings included 36 input, 39 process, 27 output, and 8 impact common indicators
for evaluating performance.
DISCUSSION: This scoping review of related literature indicated that despite differentiation in the time
and place of past studies in the field of performance evaluation models, there are some indicators
that are common in most popular performance evaluation models. These simple lists can apply for
evaluation of hospitals’ performance instead of complicated models.
Keywords
1. Adel A, Mohammadi Y. Designing a math model for hospital
performance evaluation with the FHNBSC, SAW, and LINMAP
integrated approach. Health Syst Res 2012;10:509‑24. [Last
accessed on 2019 Nov 20]Available from: http://magiran.
com/2322‑5564
2. Adel A, Valipour M, Moghbel A, Hassas Y. Efficiency
evaluation of Tehran university of medical sciences hospitals
using data envelopment analysis (2011‑2010). Health Manage
J 2013;16:36‑46. [Last accessed on 2019 Nov 20] Available
from:http://jha.iums.ac.ir/article‑1‑1305‑fa.htm.
3. Asadi M, Mirghafouri H, Sadeghi Z, Kosravsniyan H. Evaluation
of performance of Yazd public hospitals using a combination
of balanced scorecard models, data envelopment analysis and
servqual. J Shahid Sadoughi Univ Med Sci Health Serv Yazd
2010;18:559‑69. [Last accessed on 2019 Nov 20] Available from:
http://jssu.ssu.ac.ir/article‑1‑1335‑fa.html.
4. Parham M, Fotouhi M, Jandaghi M, AlipourKh. Evaluation
of performance of Shahid Beheshti hospital in Qom based
on organizational excellence model. J Qom Univ Med Sci
2014;7:79‑85. [Last accessed on 2019 Nov 20]Available from:
http://journal.muq.ac.ir/article‑1‑598‑fa.html.
5. Taslimi M, Zayandeh M. Challenges for creating a system
for evaluating the performance of the hospital: A review of
the literature and scientific work. Hakim 2014;16:35‑41. [Last
accessed on 2019 Nov 20]Available from: http://hakim.hbi.ir/
article‑1‑1132‑fa.html.
6. Khalilnezhad R, BaratiO. Hspital performance evalouatio. Health
Manage 2009;3:27‑36. [Last accessed on 2019 Nov 20]Available
from: http://jha.iums.ac.ir/article‑1‑166‑fa.html.
7. Khanzadeh A, Motlagh M, Mirshakak A, Akbari N, Niyakan M,
Pour shirvaniD. Evaluation of the performance of hospitals
affiliated to Abadan faculty of medical sciences based on the
Iranian national excellence award model. Health Inf Manage
2016;13:138‑44. [Last accessed on 2019 Nov 20] Available from:
http://magiran.com/p1563440.
8. Dargahi H, Tolouee SH, SadeghifarJ. Evaluation of performance
of hospitals affiliated with Tehran university of medical
sciences using the Pabon Lasso model. Payavard Health
2017;10:290‑8. [Last accessed on 2019 Nov 20] Available from:
http://payavard.tums.ac.ir/article‑1‑6068‑fa.html.
9. Ghandehari N, Esmaeeliyan M, Teimouri H, Ghalamkari Sh.
Evaluation of performance of Nour and Hazrat Ali Asghar
hospitals in Isfahan using a balanced scorecard combination
method and a technique for measuring attractiveness through
a series of evaluations. Health Inf Manage 2017;14:58‑64. [Last
accessed on 2019 Nov 20] Available from: http://magiran.com/
p1718495.
10. Tripathi CB, Kumar R, Sharma RC, Agarwal R. Assessment
of performance of services in a tertiary care neuropsychiatric
institute using Pabon Lasso model. Asian J Med Sci 2016;7:69‑74.
11. Dong S, Zuo Y, Guo S, Li M, Liu X, Li H. Data envelopment
analysis for relative efficiency measurements of Chinese hospitals:
A systematic review. Res Health Sci 2017;2:79‑103.
12. Karsak EE, Karadayi MA. Imprecise DEA framework for
evaluating health‑care performance of districts. Kybernetes
2017;46:706‑27.
13. Hajduová RL. Using the data envelopment analysis in evaluating
the technical efficiency in hospitals: General and new approaches.
Acta Oecon Cassoviensia 2014;19:144‑58.
14. Chuang CL, Chang PC, Lin RH. An efficiency data envelopment
analysis model reinforced by classification and regression tree for
hospital performance evaluation. J Med Syst 2011;35:1075‑83.
15. Yawe B. Hospital performance evaluation in Uganda:
A super‑efficiency data envelope analysis model. Zambia Soc Sci
J 2010;1:6. [Last accessed on 2019 Nov 20] Available from: http://
scholarship.law.cornell.edu/zssj/vol1/iss1/6.
16. Weng SJ, Wu T, Blackhurst J, Mackulak G. An extended DEA
model for hospital performance evaluation and improvement.
Health Serv Outcomes Res Methodol 2009;9:39.
17. Khani F, Naderi H, Zangeneh M, Fazeli E. Measuring the relative
efficiency of Ilam hospitals using data envelopment analysis.
Manage Sci Lett 2012;2:1189‑94.
18. Sajadi H, Sajadi Z, HadiM. Is there a method for comparing
key indicators of hospital performance? Health Inf Manage
2010;8:71‑81. [Last accessed on 2019 Nov 20] Available from:
http://ensani.ir/fa/article/262230.
19. Rahbar A, Hadi P, KhosraviM. Evaluation of the performance
of teaching hospitals in Qom and Kashan university of
medical sciences and health services and their comparative
comparison using the Pabonacci model. Health Inf Manage
2015;11:362‑70. [Last accessed on 2019 Nov 20] Available from:
http://ensani.ir/fa/article/353851.
20. Bastani P, Lotfi F, Moradi M, AhmadzadehM. Performance
analysis of educational hospitals of Shiraz university of medical
sciences before and after delivery of the health system using the
Pabon Lasso model. JRafsanjan Univ Med Sci 2016;15:781‑92.[Last
accessed on 2019 Nov 20]Available from: http://journal.rums.
ac.ir/article‑1‑3165‑fa.html.
21. Barati B, Farziyanpour F, Arab M, Rahimi A. Evaluation of
the performance of Ninth and Deh Razi hospitals in Torbat
Heydarieh city based on the Pabon Lasso model and its
comparative comparison with the national standards in
1393‑2014. J Torbat E Heydarieh Univ Med Sci 2017;5:48‑55. [Last
accessed on 2019 Nov 20]Available from:http://jms.thums.ac.ir/
article‑1‑430‑fa.html.
22. Mohammadkarim B, Jamil S, Pejman H, Seyyed MH, Mostafa N.
Combining multiple indicators to assess hospital performance in
Iran using the Pabon Lasso model. Australas Med J 2011;4:175‑9.
23. GrigoroudisE, OrfanoudakiE, ZopounidisC. Strategic performance
measurement in a healthcare organisation: A multiple criteria
approach based on balanced scorecard. Omega 2012;40:104‑19.
24. Samadi S, Gholmohammadi A, Mohammadi A, Rezapour T.
Designing an organizational performance evaluation model for NAJA hospitals. Entezami Med 2011;1:38‑45.
25. Rajoui M, Ramezan M, Hesari M, Bour bour M. Designing
performance evaluation indicators by using AHP and BSC
approaches (case of study: Social security organization of
Mashhad). Soc Welf Q 2017;17:131‑58. [Last accessed on
2019 Nov 20] Available from: http://refahj.uswr.ac.ir/
article‑1‑2867‑fa.html.
26. Tabatabaee SS, Kalhor R, Yousefi S, Taghadum‑Kangi S,
Ghamari MR. Performance evaluation of mehr hospital in
Mashhad, Iran, based on European foundation for quality
management (EFQM) organizational excellence model. Journal
of Kerman School of Management and Medical Information
2013;1:89‑1.[Last accessed on 2019 Nov 20]Available from: http://
jms.kmu.ac.ir/article‑1‑35‑fa.html.
27. Stefan MS, Pekow PS, Nsa W, Priya A, Miller LE, Bratzler DW,
et al. Hospital performance measures and 30‑day readmission
rates. J Gen Intern Med 2013;28:377‑85.
28. Arzemani M, Akaberi A, Pournaghi S. Performance evaluation
of medical records department of hospitals related to North
Khorasan university of medical sciences in 2013. J North Khorasan
Univ Med Sci 2014;6:235‑44. [Last accessed on 2019 Nov 20]
Available from: http://journal.nkums.ac.ir/article‑1‑338‑fa.html.
29. Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM.
Hospital performance trends on national quality measures and
the association with joint commission accreditation. J Hosp Med
2011;6:454‑61.
30. Glover M, Khalilzadeh O, Choy G, Prabhakar AM,
Pandharipande PV, Gazelle GS. Hospital evaluations by social
media: A comparative analysis of facebook ratings among
performance outliers. J Gen Intern Med 2015;30:1440‑6.
31. Ash AS, Fienberg SF, Louis TA, Normand SL, Stukel TA, Utts J.
Statistical issues in assessing hospital performance. Committee
of Presidents of Statistical Societies 2012;. [Last accessed on
2019 Nov 20] Available from: https://escholarship.umassmed.
edu/qhs_pp/1114 2012.
32. Bardach NS, Asteria‑Peñaloza R, Boscardin WJ, Dudley RA. The
relationship between commercial website ratings and traditional
hospital performance measures in the USA. BMJ Qual Saf
2013;22:194‑202.
33. Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS,
et al. An administrative claims measure suitable for profiling
hospital performance on the basis of 30‑day all‑cause readmission
rates among patients with heart failure. Circ Cardiovasc Qual
Outcomes 2008;1:29‑37.
34. D’Errigo P, Seccareccia F, Rosato S, Manno V, Badoni G, Fusco D,
et al. Comparison between an empirically derived model and the
euroSCORE system in the evaluation of hospital performance: The
example of the italian CABG outcome project. Eur J Cardiothorac
Surg 2008;33:325‑33.
35. Werner RM, Bradlow ET, Asch DA. Does hospital performance
on process measures directly measure high quality care or is it a
marker of unmeasured care? Health Serv Res 2008;43:1464‑84.
36. Jha AK, Orav EJ, Li Z, Epstein AM. The inverse relationship
between mortality rates and performance in the hospital quality
alliance measures. Health Aff (Millwood) 2007;26:1104‑10.
37. Shiekhzadeh R. Designing a model for evaluation and
management of the health system of the country. Management
Research. 2010;3 (10):83‑108. [Last accessed on 2019 Nov 20]
Available from: http://ensani.ir/fa/article/301140.
38. Janati A, Dadgar E, Sadegh Tabrizi J, Asghari Jafarabadi M,
GHolamzade Nikjoo R. Health system professionals, attitude
towards necessary criteria for hospitals managers, performance
assessment. Sci Mag Yafte 2012;14:91‑101. [Last accessed
on 2019 Nov 20]Available from: http://yafte.lums.ac.ir/
article‑1‑809‑fa.html.
39. Bahadori M, Izadi AR, Ghardashi F, Ravangard R, Hosseini SM.
The evaluation of hospital performance in Iran: A systematic
review article. Iran J Public Health 2016;45:855‑66.
40. Reisi‑Nafchy M, Drees F, Mirzaeian RR. Assessment of
performance indicators in hospitals university of medical
sciences based on the standards of the ministry of health.
J Shahrekord Univ Med Sci 2014;15:60‑7. [Last accessed on
2019 Nov 20]Available from: http://journal.skums.ac.ir/
article‑1‑1931‑fa.html.
41. Jahangiri A, Jahangiri M. Evaluation of hospital performance
using multi‑indicative decision making: A case study at Imam
Khomeini social security hospital, Arak. Q J Health Manage
2017;8:91‑102. [Last accessed on 2019 Nov 20]Available from:
http://jhm.srbiau.ac.ir/article_10679.html.
42. Saeedi Mehr M, Ghosi R, Emami G. Evaluating the urgency of
emergency hospital based on lean principles. Health Inf Manage
2018;15:162‑7. [Last accessed on 2019 Nov 20]Available from:
http://dx.doi.org/10.22122/him.v15i4.3554.
performance evaluation with the FHNBSC, SAW, and LINMAP
integrated approach. Health Syst Res 2012;10:509‑24. [Last
accessed on 2019 Nov 20]Available from: http://magiran.
com/2322‑5564
2. Adel A, Valipour M, Moghbel A, Hassas Y. Efficiency
evaluation of Tehran university of medical sciences hospitals
using data envelopment analysis (2011‑2010). Health Manage
J 2013;16:36‑46. [Last accessed on 2019 Nov 20] Available
from:http://jha.iums.ac.ir/article‑1‑1305‑fa.htm.
3. Asadi M, Mirghafouri H, Sadeghi Z, Kosravsniyan H. Evaluation
of performance of Yazd public hospitals using a combination
of balanced scorecard models, data envelopment analysis and
servqual. J Shahid Sadoughi Univ Med Sci Health Serv Yazd
2010;18:559‑69. [Last accessed on 2019 Nov 20] Available from:
http://jssu.ssu.ac.ir/article‑1‑1335‑fa.html.
4. Parham M, Fotouhi M, Jandaghi M, AlipourKh. Evaluation
of performance of Shahid Beheshti hospital in Qom based
on organizational excellence model. J Qom Univ Med Sci
2014;7:79‑85. [Last accessed on 2019 Nov 20]Available from:
http://journal.muq.ac.ir/article‑1‑598‑fa.html.
5. Taslimi M, Zayandeh M. Challenges for creating a system
for evaluating the performance of the hospital: A review of
the literature and scientific work. Hakim 2014;16:35‑41. [Last
accessed on 2019 Nov 20]Available from: http://hakim.hbi.ir/
article‑1‑1132‑fa.html.
6. Khalilnezhad R, BaratiO. Hspital performance evalouatio. Health
Manage 2009;3:27‑36. [Last accessed on 2019 Nov 20]Available
from: http://jha.iums.ac.ir/article‑1‑166‑fa.html.
7. Khanzadeh A, Motlagh M, Mirshakak A, Akbari N, Niyakan M,
Pour shirvaniD. Evaluation of the performance of hospitals
affiliated to Abadan faculty of medical sciences based on the
Iranian national excellence award model. Health Inf Manage
2016;13:138‑44. [Last accessed on 2019 Nov 20] Available from:
http://magiran.com/p1563440.
8. Dargahi H, Tolouee SH, SadeghifarJ. Evaluation of performance
of hospitals affiliated with Tehran university of medical
sciences using the Pabon Lasso model. Payavard Health
2017;10:290‑8. [Last accessed on 2019 Nov 20] Available from:
http://payavard.tums.ac.ir/article‑1‑6068‑fa.html.
9. Ghandehari N, Esmaeeliyan M, Teimouri H, Ghalamkari Sh.
Evaluation of performance of Nour and Hazrat Ali Asghar
hospitals in Isfahan using a balanced scorecard combination
method and a technique for measuring attractiveness through
a series of evaluations. Health Inf Manage 2017;14:58‑64. [Last
accessed on 2019 Nov 20] Available from: http://magiran.com/
p1718495.
10. Tripathi CB, Kumar R, Sharma RC, Agarwal R. Assessment
of performance of services in a tertiary care neuropsychiatric
institute using Pabon Lasso model. Asian J Med Sci 2016;7:69‑74.
11. Dong S, Zuo Y, Guo S, Li M, Liu X, Li H. Data envelopment
analysis for relative efficiency measurements of Chinese hospitals:
A systematic review. Res Health Sci 2017;2:79‑103.
12. Karsak EE, Karadayi MA. Imprecise DEA framework for
evaluating health‑care performance of districts. Kybernetes
2017;46:706‑27.
13. Hajduová RL. Using the data envelopment analysis in evaluating
the technical efficiency in hospitals: General and new approaches.
Acta Oecon Cassoviensia 2014;19:144‑58.
14. Chuang CL, Chang PC, Lin RH. An efficiency data envelopment
analysis model reinforced by classification and regression tree for
hospital performance evaluation. J Med Syst 2011;35:1075‑83.
15. Yawe B. Hospital performance evaluation in Uganda:
A super‑efficiency data envelope analysis model. Zambia Soc Sci
J 2010;1:6. [Last accessed on 2019 Nov 20] Available from: http://
scholarship.law.cornell.edu/zssj/vol1/iss1/6.
16. Weng SJ, Wu T, Blackhurst J, Mackulak G. An extended DEA
model for hospital performance evaluation and improvement.
Health Serv Outcomes Res Methodol 2009;9:39.
17. Khani F, Naderi H, Zangeneh M, Fazeli E. Measuring the relative
efficiency of Ilam hospitals using data envelopment analysis.
Manage Sci Lett 2012;2:1189‑94.
18. Sajadi H, Sajadi Z, HadiM. Is there a method for comparing
key indicators of hospital performance? Health Inf Manage
2010;8:71‑81. [Last accessed on 2019 Nov 20] Available from:
http://ensani.ir/fa/article/262230.
19. Rahbar A, Hadi P, KhosraviM. Evaluation of the performance
of teaching hospitals in Qom and Kashan university of
medical sciences and health services and their comparative
comparison using the Pabonacci model. Health Inf Manage
2015;11:362‑70. [Last accessed on 2019 Nov 20] Available from:
http://ensani.ir/fa/article/353851.
20. Bastani P, Lotfi F, Moradi M, AhmadzadehM. Performance
analysis of educational hospitals of Shiraz university of medical
sciences before and after delivery of the health system using the
Pabon Lasso model. JRafsanjan Univ Med Sci 2016;15:781‑92.[Last
accessed on 2019 Nov 20]Available from: http://journal.rums.
ac.ir/article‑1‑3165‑fa.html.
21. Barati B, Farziyanpour F, Arab M, Rahimi A. Evaluation of
the performance of Ninth and Deh Razi hospitals in Torbat
Heydarieh city based on the Pabon Lasso model and its
comparative comparison with the national standards in
1393‑2014. J Torbat E Heydarieh Univ Med Sci 2017;5:48‑55. [Last
accessed on 2019 Nov 20]Available from:http://jms.thums.ac.ir/
article‑1‑430‑fa.html.
22. Mohammadkarim B, Jamil S, Pejman H, Seyyed MH, Mostafa N.
Combining multiple indicators to assess hospital performance in
Iran using the Pabon Lasso model. Australas Med J 2011;4:175‑9.
23. GrigoroudisE, OrfanoudakiE, ZopounidisC. Strategic performance
measurement in a healthcare organisation: A multiple criteria
approach based on balanced scorecard. Omega 2012;40:104‑19.
24. Samadi S, Gholmohammadi A, Mohammadi A, Rezapour T.
Designing an organizational performance evaluation model for NAJA hospitals. Entezami Med 2011;1:38‑45.
25. Rajoui M, Ramezan M, Hesari M, Bour bour M. Designing
performance evaluation indicators by using AHP and BSC
approaches (case of study: Social security organization of
Mashhad). Soc Welf Q 2017;17:131‑58. [Last accessed on
2019 Nov 20] Available from: http://refahj.uswr.ac.ir/
article‑1‑2867‑fa.html.
26. Tabatabaee SS, Kalhor R, Yousefi S, Taghadum‑Kangi S,
Ghamari MR. Performance evaluation of mehr hospital in
Mashhad, Iran, based on European foundation for quality
management (EFQM) organizational excellence model. Journal
of Kerman School of Management and Medical Information
2013;1:89‑1.[Last accessed on 2019 Nov 20]Available from: http://
jms.kmu.ac.ir/article‑1‑35‑fa.html.
27. Stefan MS, Pekow PS, Nsa W, Priya A, Miller LE, Bratzler DW,
et al. Hospital performance measures and 30‑day readmission
rates. J Gen Intern Med 2013;28:377‑85.
28. Arzemani M, Akaberi A, Pournaghi S. Performance evaluation
of medical records department of hospitals related to North
Khorasan university of medical sciences in 2013. J North Khorasan
Univ Med Sci 2014;6:235‑44. [Last accessed on 2019 Nov 20]
Available from: http://journal.nkums.ac.ir/article‑1‑338‑fa.html.
29. Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM.
Hospital performance trends on national quality measures and
the association with joint commission accreditation. J Hosp Med
2011;6:454‑61.
30. Glover M, Khalilzadeh O, Choy G, Prabhakar AM,
Pandharipande PV, Gazelle GS. Hospital evaluations by social
media: A comparative analysis of facebook ratings among
performance outliers. J Gen Intern Med 2015;30:1440‑6.
31. Ash AS, Fienberg SF, Louis TA, Normand SL, Stukel TA, Utts J.
Statistical issues in assessing hospital performance. Committee
of Presidents of Statistical Societies 2012;. [Last accessed on
2019 Nov 20] Available from: https://escholarship.umassmed.
edu/qhs_pp/1114 2012.
32. Bardach NS, Asteria‑Peñaloza R, Boscardin WJ, Dudley RA. The
relationship between commercial website ratings and traditional
hospital performance measures in the USA. BMJ Qual Saf
2013;22:194‑202.
33. Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS,
et al. An administrative claims measure suitable for profiling
hospital performance on the basis of 30‑day all‑cause readmission
rates among patients with heart failure. Circ Cardiovasc Qual
Outcomes 2008;1:29‑37.
34. D’Errigo P, Seccareccia F, Rosato S, Manno V, Badoni G, Fusco D,
et al. Comparison between an empirically derived model and the
euroSCORE system in the evaluation of hospital performance: The
example of the italian CABG outcome project. Eur J Cardiothorac
Surg 2008;33:325‑33.
35. Werner RM, Bradlow ET, Asch DA. Does hospital performance
on process measures directly measure high quality care or is it a
marker of unmeasured care? Health Serv Res 2008;43:1464‑84.
36. Jha AK, Orav EJ, Li Z, Epstein AM. The inverse relationship
between mortality rates and performance in the hospital quality
alliance measures. Health Aff (Millwood) 2007;26:1104‑10.
37. Shiekhzadeh R. Designing a model for evaluation and
management of the health system of the country. Management
Research. 2010;3 (10):83‑108. [Last accessed on 2019 Nov 20]
Available from: http://ensani.ir/fa/article/301140.
38. Janati A, Dadgar E, Sadegh Tabrizi J, Asghari Jafarabadi M,
GHolamzade Nikjoo R. Health system professionals, attitude
towards necessary criteria for hospitals managers, performance
assessment. Sci Mag Yafte 2012;14:91‑101. [Last accessed
on 2019 Nov 20]Available from: http://yafte.lums.ac.ir/
article‑1‑809‑fa.html.
39. Bahadori M, Izadi AR, Ghardashi F, Ravangard R, Hosseini SM.
The evaluation of hospital performance in Iran: A systematic
review article. Iran J Public Health 2016;45:855‑66.
40. Reisi‑Nafchy M, Drees F, Mirzaeian RR. Assessment of
performance indicators in hospitals university of medical
sciences based on the standards of the ministry of health.
J Shahrekord Univ Med Sci 2014;15:60‑7. [Last accessed on
2019 Nov 20]Available from: http://journal.skums.ac.ir/
article‑1‑1931‑fa.html.
41. Jahangiri A, Jahangiri M. Evaluation of hospital performance
using multi‑indicative decision making: A case study at Imam
Khomeini social security hospital, Arak. Q J Health Manage
2017;8:91‑102. [Last accessed on 2019 Nov 20]Available from:
http://jhm.srbiau.ac.ir/article_10679.html.
42. Saeedi Mehr M, Ghosi R, Emami G. Evaluating the urgency of
emergency hospital based on lean principles. Health Inf Manage
2018;15:162‑7. [Last accessed on 2019 Nov 20]Available from:
http://dx.doi.org/10.22122/him.v15i4.3554.
)