Table 5 Results of the qualitative analysis regarding criticism from the physicians’ perspective
Topic of the criticism | N | Examples |
|---|---|---|
Flaws of underlying data (e.g., timeliness, risk-adjustment, validity, risk of manipulation) | 38 | • “The number of cases based on insurance claims data is not sufficiently large” • “Individual data are too often manipulated” |
Design (e.g., type size, placement of information, rank order, traffic light colors) | 21 | • “The alphabetical order is not helpful” • “Tables with insurance claims data include terms far too complex” |
Missing of further quality information (e.g., PROMs, satisfaction of referring physicians) | 20 | • “Access to hospitals is not included” • “You should survey referring physicians” |
Impact of the public reporting initiative (e.g., risk of misinformation, short-term impact) | 11 | • “Experience shows that such actions cause uncertainty for patients” • “The effect is of limited duration” |
Methodology for deriving the quality scores (e.g., weighting of quality information) | 10 | • “The methodical approach to deal with this issue does not reflect reality” • “The data were not assessed accurately” |
Publication media (e.g., daily newspaper inappropriate) | 10 | • “I do not use quality information provided by a newspaper” • “I believe that the newspaper NZ is not the appropriate media to publish scientific data” |
Other factors more relevant (e.g., own experience, patient preference, distance) | 10 | • “I rely on results which I can see on patients and patients’ experiences myself” • “Personal experiences are more important” |
Hospital related issues (e.g., ownership structure) | 8 | • “No consideration of multi-morbid patients, which are treated in small hospitals - > bad grade of large hospitals” • “Regarding the fact that “private hospitals” treat very highly selected patients (e.g. no risk patients), it is difficult to compare the number of cases and statistical analysis regarding mortality with local community hospitals” |
Transparency (e.g., funding, methodology, conflict of interests) | 5 | • “Was there any relationship with the newspaper? (conflict of interests)?” • “I don’t know about the significance of the criteria, the transparency is questionable” |
Ranking does not match physicians’ experience | 4 | • “Based on daily practice some hospitals are overrated” • “I was treated in hospitals which are rated as under-performer and I was extremely satisfied” |
Structural changes in hospitals | 3 | • “Structures are changing quickly” • “Since 2013/2014 several surgeons have been changing hospitals (retirement, other hospital!)” |
Scope of the public reporting initiative | 3 | • “A smaller number of hospitals would be easier to recognize” • “I cautiously read the Focus hospital ranking which contains also the remaining hospitals in Germany” |
Subjectivity of the ranking | 2 | • “In my opinion such rankings are usually created by persons who have no or less insight in daily routines of a hospital. As a result subjective opinions/impressions are included” • “Shouldn’t there be more newspapers or institutes to conduct such a ranking?” |
No specific reasons stated | 2 | • “Rankings seem generally suspicious to me” • “Rankings are very meaningful for the majority of the population. Whether rankings present the exact condition of hospitals is questionable” |