Performance management, developing a culture of measurement and continuous quality improvement in Estonian hospitals, WHO/Europe 2009

Estonia is currently at a crossroads in hospital performance management. In 2001, the country embarked on hospital governance reform with the introduction of new management structures (management boards and supervisory boards). Other initiatives and reforms have been implemented over the last years to hold hospitals accountable for measurable results and to foster a culture of continuous quality. Estonia joined the performance assessment tool for quality improvement in hospitals (PATH) network for its second wave of data collection and analysis in 2007 (PATH-II). The PATH coordination is assured by the Estonian Health Insurance Fund (EHIF). Its involvement in PATH is motivated by its objective to support and promote comprehensive development of health care in Estonia, in addition to its core financing of health services. The EHIF aims to “purchase not only quantity of services but also quality of services” by means of e.g. fine-tuning contracts with a quality clause, supporting the development and implementation of clinical guidelines, performing clinical audits, and developing pay-for-performance incentives. This report aims to review whether or to what extent these changes have improved performance management practices.