Data-Driven Healthcare: WHO's Strategic Indicators for Better Outcomes in Romania

The WHO guidebook introduces 25 quality of care indicators to improve patient safety, healthcare outcomes, and data-driven decision-making in Romanian hospitals. It aims to foster continuous improvement and align the healthcare system with international standards for better care delivery and universal health coverage.

The World Health Organization's Regional Office for Europe, in collaboration with Romanian health professionals and experts from institutions such as Amsterdam University Medical Centre and the University of Medicine and Pharmacy “Carol Davila,” developed the technical guidebook Quality of Care Indicators to Support Implementation of the Health Quality Fund in Romania. This guidebook aims to improve the quality of care and patient safety in Romanian hospitals through the implementation of evidence-based quality indicators. The initiative is part of Romania’s broader healthcare reform, which aligns with the European Commission’s Recovery and Resilience Plan (RRP), designed to support critical investments and reforms across multiple sectors, including healthcare. Romania's healthcare system faces numerous challenges, including high mortality rates from preventable diseases, low life expectancy, and significant pressure from the COVID-19 pandemic. Cardiovascular disease, cancer, and pneumonia are the leading causes of death, exacerbated by a healthcare system that has long been underfunded and centralized. Health expenditure in Romania remains one of the lowest in the European Union, accounting for only 6.5% of the country’s GDP, with a disproportionate amount spent on inpatient care. The technical guidebook seeks to address these challenges by fostering a culture of continuous improvement and learning within Romania's public healthcare sector, emphasizing data-driven decision-making and patient-centered care.

Strengthening Patient Safety through Evidence-Based Indicators

The guidebook introduces 25 quality of care (QoC) indicators, which were carefully selected based on their relevance to patient safety, feasibility, and the current priorities of the Romanian healthcare system. These indicators cover key areas such as reducing healthcare-associated infections (HAIs), improving patient experiences, enhancing workforce training, and measuring the effectiveness of hospital care. The indicators were developed using a multistep approach, involving in-depth reviews of available evidence, stakeholder consultations, and situation analyses of the Romanian healthcare system. Their implementation is expected to improve Romania's healthcare outcomes by providing hospitals with clear, actionable data to monitor and evaluate their performance. Importantly, the guidebook emphasizes the need for data collection and monitoring, which are critical to achieving these improvements. Standardized methodologies, such as infection reporting forms, patient satisfaction surveys, and clinical auditing procedures, are prescribed to ensure consistency and reliability in measuring healthcare outcomes.

Combatting Healthcare-Associated Infections

A major focus of the guidebook is patient safety, particularly in reducing healthcare-associated infections (HAIs), which remain a significant cause of morbidity and mortality in Romania. Specific indicators, such as the central line-associated bloodstream infection (CLABSI) rate and surgical site infection (SSI) rate, are aimed at reducing the incidence of infections acquired during hospital stays. The guidebook provides detailed methodologies for collecting and analyzing data related to these infections, with a strong emphasis on prevention and control measures. For example, hospitals are encouraged to adopt the WHO Surgical Safety Checklist for all surgical procedures to minimize the risk of postoperative complications. Other patient safety indicators focus on preventing falls and pressure ulcers in hospitalized patients, two common and preventable causes of extended hospital stays and increased healthcare costs. These indicators are designed to help hospitals identify at-risk patients early and implement appropriate interventions to prevent harm.

Improving Patient Experience through Systematic Feedback

In addition to patient safety, the guidebook addresses the importance of improving patient experiences. Two key indicators patient experience questionnaire completion rate and post-discharge patient experience score are intended to capture patients’ perceptions of the care they receive. Hospitals are encouraged to distribute standardized questionnaires to all discharged patients and to actively seek feedback from patients to identify areas for improvement. By systematically measuring patient satisfaction, hospitals can prioritize interventions that enhance the overall patient experience and contribute to better health outcomes.

Empowering Healthcare Workers with Continuous Training

Workforce training is another critical area covered by the guidebook. The guidebook includes indicators that measure the participation of healthcare professionals in quality of care and patient safety training activities, as well as the adherence of staff to post-exposure protocols following sharps injuries. By promoting continuous education and training, the guidebook aims to ensure that healthcare workers are equipped with the necessary skills and knowledge to provide high-quality, safe care. Hospitals are encouraged to track the participation of healthcare staff in these training programs and to incorporate the findings into their quality improvement efforts.

Building a More Resilient and Effective Healthcare System

Ultimately, the guidebook seeks to align Romania’s healthcare system with international standards by promoting transparent, data-driven decision-making and a strong focus on patient-centered care. By providing hospitals with the tools and methodologies needed to monitor and improve their performance, the guidebook aims to create a more efficient, resilient, and effective healthcare system. This shift is particularly important as Romania works towards achieving universal health coverage (UHC), a key goal of the World Health Organization's 2030 Agenda for Sustainable Development. By focusing on patient safety, improving care quality, and enhancing workforce training, the guidebook represents a significant step forward in strengthening Romania’s healthcare system and ensuring better health outcomes for all citizens. The pilot phase, currently being implemented in six hospitals across the country, will provide valuable insights into the feasibility of scaling these initiatives nationwide, fostering a culture of learning and continuous improvement across the Romanian healthcare sector.