Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study

BMJ Open Qual. 2020 Jun;9(2):e000812. doi: 10.1136/bmjoq-2019-000812.


Background: International hospital accreditation instruments, such as Joint Commission International (JCI) and Qmentum, focus mainly on hospital policy and procedures and do not specifically cover a profession such as hospital-based physiotherapy. This justifies the need for a quality system to which hospital-based physiotherapy can better identify, based on a common framework of quality indicators for effective quality management.

Objective: This study aimed to identify the most important quality indicators of a hospital-based physiotherapy department in the eyes of hospital-based physiotherapists and their managers.

Methods: Based on input from three focus groups and a structured literature review, a first set of quality indicators for hospital physiotherapy was assembled. After checking this set for duplicates and for overlap with JCI and Qmentum, it formed the starting point of a modified Delphi procedure. In two rounds, 17 hospital-based physiotherapy experts rated the quality indicators on relevance through online surveys. In a final consensus meeting, quality indicators were established, classified in quality themes and operationalised by describing for each theme the rationale, specifications, domain and type of indicator.

Results: Three focus groups provided 120 potential indicators, which were complemented with 18 potential indicators based on literature. After duplicate and overlap check and the Delphi procedure, these 138 potential indicators were reduced to a set of 56 quality indicators for hospital-based physiotherapy. Finally, these 56 indicators were condensed into 7 composite indicators, each representing a quality theme based on definitions of the European Foundation for Quality Management.

Conclusion: A set of 56 quality indicators, condensed into 7 composite indicators each representing a quality theme, was developed to assess the quality of a hospital-based physiotherapy department.

Keywords: continuous quality improvement; healthcare quality improvement; hospital medicine; quality improvement; standards of care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Delphi Technique
  • Female
  • Focus Groups / methods
  • Humans
  • Interviews as Topic / methods
  • Male
  • Middle Aged
  • Physical Therapists / standards
  • Physical Therapists / statistics & numerical data
  • Physical Therapy Specialty / standards*
  • Qualitative Research
  • Quality Indicators, Health Care*
  • Surveys and Questionnaires