OUR QUALITY INDICATORS

Quality indicators are regularly monitored and evaluated to ensure the effectiveness, safety, and continuity of the healthcare services provided at our hospital. These indicators objectively demonstrate our performance in key areas such as patient safety, clinical outcomes, service efficiency, and patient satisfaction.

Data obtained through our quality management system are analyzed in accordance with national and international standards and serve as a foundation for our continuous improvement initiatives. In line with our commitment to transparency and accountability, we publicly share our quality indicator results for the relevant reporting periods.

The indicators presented below illustrate some of the initiatives undertaken to enhance the quality of care delivered by our hospital in alignment with established performance targets. In the following sections, you will find detailed information for each quality indicator, including its definition and purpose, the methodology used for measurement, our performance results, and an assessment of these results in comparison with international benchmarks and reference standards.

HOSPITAL PATIENT SURVEYS

Why Do We Monitor This Indicator?

Enhancing patient satisfaction, one of the primary objectives of healthcare institutions, reflects the extent to which patients’ expectations and needs are being met. Patient feedback also serves as an important measurement tool in organizations’ quality improvement efforts.

Patients’ opinions regarding their satisfaction and experiences during their hospital stay are recognized as key indicators of service quality. Achieving excellence in this area requires actively seeking patients’ perspectives and experiences and accurately understanding their expectations.

What Methodology Do We Use?

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a standardized survey designed to measure patients’ experiences in hospitals across the United States. Developed by CMS (Centers for Medicare & Medicaid Services), the U.S. federal agency responsible for administering public health insurance programs, the use of this survey is mandatory for all hospitals in the United States. The Turkish version of the survey has undergone validity and reliability analyses and is also used at Anadolu Health Center Hospital to assess inpatient experience and satisfaction.

Through the Hospital Compare website, it is possible to review and compare the results of standardized performance indicators reported by hospitals throughout the United States. As Anadolu Health Center Hospital, our primary reason for using the HCAHPS Inpatient Survey is to enable such international benchmarking.

All indicators related to inpatient experience are evaluated not only against Anadolu Health Center (AHC) results but also in comparison with results from Johns Hopkins Medicine (JHM) and national HCAHPS averages from the United States for international benchmarking purposes.

The comparison dataset includes AHC results from the January 2025–December 2025 period and U.S. average results published in the January 2026 update of the CMS Care Compare platform, which covers the data collection period from April 2024 through March 2025.

The main reason for using JHM and U.S. national averages as benchmarks is the absence of a national dataset within the Turkish healthcare system that has been developed using the same methodology and allows for inter-institutional comparisons.

Within the scope of these indicators, our goal is to maintain patient experience and satisfaction levels at 88% or higher.

What Do We Measure?

• Overall Satisfaction

• Likelihood to Recommend

• Nurse Communication

• Physician Communication

• Responsiveness of Hospital Staff

• Communication About Medications

• Cleanliness of the Room at All Times

• Quietness of the Room and Surrounding Environment

• Discharge Information

a. Overall Satisfaction

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following question included in the Inpatient Satisfaction Survey administered after discharge:

“Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital?”

Results are calculated according to the HCAHPS methodology. Under this approach, the number of surveys in which patients give the highest rating (9 or 10) is divided by the total number of responses to this question. The resulting percentage represents the Overall Satisfaction rate.

b. Likelihood to Recommend

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following question included in the Inpatient Satisfaction Survey administered after discharge:

“Would you recommend our hospital to your family and friends?”

Results are calculated according to the HCAHPS methodology. Under this approach, the number of surveys in which patients selected the highest response category, “Definitely yes,” is divided by the total number of responses to this question. The resulting percentage represents the Likelihood to Recommend rate.

c. Nurse Communication

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following questions included in the “Our Nurses” section of the Inpatient Satisfaction Survey administered after discharge:

• During this hospital stay, did our nurses treat you with courtesy and respect?

• During this hospital stay, did our nurses listen carefully to you?

• During this hospital stay, did our nurses explain things about your care in a way you could understand?

Results are calculated according to the HCAHPS methodology. For each question, the result is determined by dividing the number of surveys in which patients selected the highest response category, “Always,” by the total number of responses to that question. The Nurse Communication rate is calculated as the arithmetic mean of the results obtained for these three questions.

d. Physician Communication

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following questions included in the “Our Physicians” section of the Inpatient Satisfaction Survey administered after discharge:

• During this hospital stay, did our physicians treat you with courtesy and respect?

• During this hospital stay, did our physicians listen carefully to you?

• During this hospital stay, did our physicians explain matters related to your illness and treatment in a way you could understand?

Results are calculated according to the HCAHPS methodology. For each question, the result is determined by dividing the number of surveys in which patients selected the highest response category, “Always,” by the total number of responses to that question. The Physician Communication rate is calculated as the arithmetic mean of the results obtained for these three questions.

e. Responsiveness of Hospital Staff

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following questions included in the Inpatient Satisfaction Survey administered after discharge:

• During this hospital stay, after you pressed the nurse call button, did our nurses come to your room as soon as you needed help?

• During this hospital stay, when you requested assistance to use the toilet or a bedpan, did our healthcare staff assist you promptly?

Results are calculated according to the HCAHPS methodology. For each question, the result is determined by dividing the number of surveys in which patients selected the highest response category, “Always,” by the total number of responses to that question. The Responsiveness of Hospital Staff rate is calculated as the arithmetic mean of the results obtained for these two questions.

f. Communication About Medications

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following questions included in the “Your Experiences in the Hospital” section of the Inpatient Satisfaction Survey administered after discharge:

• Were you informed about the purpose of any new medication that was started during your hospital stay?

• Were you informed about the possible side effects of any new medication that was started during your hospital stay?

Results are calculated according to the HCAHPS methodology. Under this approach, the number of surveys in which patients selected the highest response category, “Always,” is divided by the total number of responses to these questions. The resulting percentage represents the Communication About Medications rate.

g. Cleanliness of the Hospital Environment

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following question included in the “Our Hospital Environment” section of the Inpatient Satisfaction Survey administered after discharge:

• During this hospital stay, were your room and bathroom kept clean?

Results are calculated according to the HCAHPS methodology. Under this approach, the number of surveys in which patients selected the highest response category, “Always,” is divided by the total number of responses to this question. The resulting percentage represents the Cleanliness Rate.

h. Quietness of the Hospital Environment

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following question included in the “Our Hospital Environment” section of the Inpatient Satisfaction Survey administered after discharge:

• During this hospital stay, was your room and its surrounding area quiet at night?

Results are calculated according to the HCAHPS methodology. Under this approach, the number of surveys in which patients selected the highest response category, “Always,” is divided by the total number of responses to this question. The resulting percentage represents the Quietness Rate.

i. Discharge Information

How Do We Monitor It?

This indicator is measured based on patients’ responses to the following questions included in the “Leaving Our Hospital” section of the Inpatient Satisfaction Survey administered after discharge:

• Before leaving the hospital, did staff discuss with you whether you would have the help you needed after discharge?

• Did you receive written information describing symptoms or health problems to watch for after you left the hospital?

The number of surveys in which patients responded “Yes” is divided by the total number of responses to these questions. The resulting percentage represents the Discharge Information rate.

CLINICAL INDICATORS

The following performance indicators related to Clinical Quality are presented below:

• Rate of Venous Thromboembolism (VTE) Prophylaxis Administered Within 24 Hours of Hospital Admission or Surgery

• Effective Communication: Appropriate Transfer Rate from the Emergency Department to Inpatient Units

a. Rate of VTE Prophylaxis Administered Within 24 Hours of Hospital Admission or Surgery

Why Do We Monitor This Indicator?

The development of blood clots in the veins of hospitalized patients (Venous Thromboembolism – VTE) and the subsequent occurrence of blood clots in the pulmonary arteries (pulmonary embolism) may lead to serious complications and can sometimes be fatal.

A risk assessment is performed to identify patients who are at risk for VTE. Appropriate preventive actions should be taken to minimize the identified risk, and thromboprophylaxis should be initiated in a timely manner. If prophylactic treatment cannot be initiated, the reasons for withholding prophylaxis must also be documented.

For patients receiving thromboprophylaxis, the intervention should be administered in accordance with the identified risk score and established clinical guidelines.

How Do We Monitor It?

For this clinical indicator, medical records of hospitalized patients selected through a random sampling methodology are reviewed. These records are evaluated to determine whether a VTE risk assessment was completed within the first 24 hours and, if indicated, whether appropriate thromboprophylaxis was initiated.

The proportion of patients who received the appropriate intervention is monitored on a monthly basis.

Our 2025 Target

To maintain the VTE prophylaxis administration rate at 96% or higher.

b. Effective Communication: Appropriate Transfer Rate from the Emergency Department to Inpatient Units

Why Do We Monitor This Indicator?

Inadequate communication among healthcare providers can lead to adverse outcomes. For this reason, patient safety initiatives are implemented to promote effective communication throughout the continuum of care.

Recognizing that the transfer of information during patient handoffs is critical to the treatment process, we monitor the accuracy and completeness of handoffs among healthcare professionals involved in patient care as a quality indicator.

How Do We Monitor It?

For this clinical indicator, medical records of patients transferred from the Emergency Department to inpatient units are reviewed. The patient transfer form, which is required to be included in the medical record, is evaluated to determine whether it has been completed accurately and comprehensively. Properly completed forms indicate that patient information has been communicated correctly during the transfer process.

Our 2025 Target

To maintain the appropriate transfer rate from the Emergency Department to inpatient units at 95% or higher.

EFFICIENCY

Efficiency indicators are regularly monitored to evaluate the effectiveness of our service processes, the efficient use of resources, and our sustainability performance. These indicators encompass key performance areas that support both our environmental responsibility goals and the efficiency of care delivery processes.

a. Medical Waste Generation (kg per Inpatient Day)

As part of our environmental sustainability approach, the amount of medical waste generated per inpatient day is monitored regularly. The data obtained guide our continuous improvement efforts aimed at reducing waste, promoting the efficient use of resources, and minimizing environmental impact.

Why Do We Monitor This Indicator?

Monitoring medical waste generation per inpatient day helps identify processes that produce higher-than-expected amounts of waste. This enables us to detect errors, such as the improper disposal of domestic waste as medical waste, and to reduce waste generation at its source.

Medical waste is monitored to assess operational efficiency, ensure proper waste segregation, maintain cost control, and minimize environmental risks.

How Do We Monitor It?

The total amount of medical waste collected from all departments is divided by the total number of inpatient days for the month to calculate the indicator expressed as kilograms per inpatient day (kg/inpatient day).

b. Emergency Department Revisit Rate

Why Do We Monitor This Indicator?

To evaluate the effectiveness of emergency department services and the continuity of care processes, emergency department revisit rates within a specified period are monitored regularly. This indicator serves as an important measure for assessing the effectiveness of the initial evaluation, treatment plan, and discharge instructions provided during the patient's first visit.

Monitoring this indicator enables us to:

• Promote the efficient use of emergency department resources by reducing avoidable repeat visits;

• Improve service efficiency by decreasing overcrowding and waiting times;

• Assess whether patients are being directed to the most appropriate level of care;

• Monitor the effectiveness and sustainability of clinical decision-making processes; and

• Contribute to cost-effectiveness by reducing unnecessary admissions, diagnostic tests, and repeat interventions.

How Do We Monitor It?

This indicator represents the proportion of patients who return to the Emergency Department within 24 hours for the same complaint relative to the total number of Emergency Department visits.

The denominator includes all Emergency Department visits, while the numerator includes only revisits for the same complaint within 24 hours. Visits that are considered a continuation of the patient's ongoing treatment process are excluded from the calculation.