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Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study
  1. Rudi A Steenbruggen1,2,
  2. Roel van Oorsouw3,
  3. Marjo Maas1,4,
  4. Thomas J Hoogeboom1,
  5. Paul Brand5,6,
  6. Philip van der Wees1
  1. 1IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
  2. 2School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
  3. 3Physiotherapy, Radboudumc, Nijmegen, The Netherlands
  4. 4Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
  5. 5Medical Education, Isala Hospitals, Zwolle, The Netherlands
  6. 6Clinical Education, UMCG, Groningen, The Netherlands
  1. Correspondence to Rudi A Steenbruggen; r.a.steenbruggen{at}


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.

  • continuous quality improvement
  • healthcare quality improvement
  • hospital medicine
  • quality improvement
  • standards of care

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  • Contributors RS designed the work, collected, analysed and interpreted the data, and wrote the draft of the manuscript. RvO collected, analysed and interpreted the data, provided critical feedback on drafts of the manuscript and finally approved this version to be published. TJH and MM contributed to the analysis of the write up of the study results, the development of the manuscript and finally approved this version to be published. PB and PvdW contributed to the design and methodology, provided critical feedback on drafts of the manuscript, supervised the study and finally approved this version to be published.

  • Funding This study was funded by the Dutch Association of Physical Therapy in Hospitals (NVZF).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data consist only of deidentified participant data during two stages of the Delphi procedure. After a reasonable request to the first author, these data are available.

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