New publication in BMJ Quality & Safety

Key Message

The rapid growth of quality indicators in healthcare has made it difficult to identify which quality indicators are most suitable for monitoring. QUALICATOR provides a transparent and structured instrument for collecting, evaluating, and prioritising quality indicators and was piloted in the Swiss context for selecting quality indicators for quality monitoring.

Background

Health systems increasingly rely on quality indicators to assess provider performance and patient outcomes. However, the number of available quality indicators has grown substantially over recent years, creating complexity, administrative burden, and uncertainty regarding which quality indicators should be prioritised. Existing quality indicator selection methods often lack transparency and standardisation.

This publication was developed as part of an ongoing projection commissioned by the Swiss Federal Quality Commission (FQC). Click here for more information on the project.

Methods

The QUALICATOR instrument was developed from an international literature review and in collaboration with experts from Switzerland representing six healthcare areas: inpatient care, outpatient care, psychiatric care, rehabilitative care, long-term care, and community care (i.e., pharmacies and rescue services).

The development process included:

• Identification and consolidation of quality indicator prioritisation criteria from the scientific literature
• Use of the Analytic Hierarchy Process (AHP) to account for healthcare-area-specific priorities
• Testing and refinement of the instrument through expert feedback and application across the six healthcare areas

Results and Outlook

The final QUALICATOR instrument consists of five steps: (i) defining the search scope, (ii) collecting quality indicators, (iii) assessing quality indicators against 12 prioritisation criteria, (iv) applying knockout criteria, and (v) conducting a final weighted prioritisation. The instrument evaluates quality indicators across four dimensions covering 12 prioritisation criteria: relevance, scientific soundness, usability, and feasibility.

The Swiss application provides an initial proof of concept for the instrument. Further validation in different countries, healthcare systems, and stakeholder groups is required before the QUALICATOR can be considered a fully validated instrument.

Implications for Practice & Policy

QUALICATOR offers policymakers, regulators, providers, payers, and researchers a transparent and scalable method for selecting quality indicators for quality measurement. The instrument may help to reduce measurement burden and administrative costs while improving the usefulness of quality monitoring.

Publication

Title: Welcome to the Jungle: Collection and Evaluation of Quality Indicators with the QUALICATOR Instrument

Published in: BMJ Quality & Safety

You can read the full study here: https://doi.org/10.1136/bmjqs-2026-020265