Trends and Insights in Global Hospital Quality of Care Research: Implications for Health Leadership and Service Improvement
DOI:
https://doi.org/10.56294/hl2025745Keywords:
Bibliometric Analysis, Healthcare Quality, Hospital Quality Indicators, Patient Safety, Hospital Performance AssessmentAbstract
Introduction: improving healthcare quality has become a global priority, yet a comprehensive analysis of hospital healthcare quality research over the past two decades is still missing. This study aims to comprehensively analyze the global research landscape on hospital healthcare quality over the past two decades through a bibliometric approach. Specifically, it seeks to identify publication trends, geographic distribution, collaboration patterns, key thematic clusters, and evolving research priorities, while highlighting existing gaps and potential future directions in hospital healthcare quality research.
Methods: this study examine the development of this field through a bibliometric analysis of 836 publications from the Scopus database (2004–2025), using OpenRefine, Bibliometrix, VOSviewer, and Tableau.
Results: the analysis reveals a steady annual publication growth rate of 2.7 and a dominant contribution from the United States (45.5%). International collaboration remains limited (13.4%), with most research originating from academic institutions. Keyword co-occurrence analysis identified three major research clusters: conceptual-managerial frameworks, methodological-epidemiological approaches, and specific patient safety indicators. Over time, the focus of research has shifted from clinical complications to quality frameworks and patient-centered systems. Key gaps include uneven geographic representation, limited global validation of quality indicators, minimal integration of patient perspectives, and difficulty in measuring qualitative aspects of hospital care.
Conclusions: future research will likely focus on digital technologies, artificial intelligence, value-based care, and equity-oriented system approaches. This study offers a foundational overview of the field’s evolution and highlights areas for future investigation.
References
1. Donabedian A. Evaluating the Quality of Medical Care. Milbank Q. 2005;83(4):691-729. doi:10.1111/j.1468-0009.2005.00397.x DOI: https://doi.org/10.1111/j.1468-0009.2005.00397.x
2. Mohammad Mosadeghrad A. Healthcare service quality: towards a broad definition. Int J Health Care Qual Assur. 2013;26(3):203-219. doi:10.1108/09526861311311409 DOI: https://doi.org/10.1108/09526861311311409
3. Parasuraman A, Zaithaml VA, L. ABL. SERVQUAL : A Multiple-Item Scale for Measuring Consumer Perceptions of Service Quality. J Retail. 1988;64(January):12-35.
4. Fatima T, Malik SA, Shabbir A. Hospital healthcare service quality, patient satisfaction and loyalty. Int J Qual Reliab Manag. 2018;35(6):1195-1214. doi:10.1108/IJQRM-02-2017-0031 DOI: https://doi.org/10.1108/IJQRM-02-2017-0031
5. Lee D. HEALTHQUAL: a multi-item scale for assessing healthcare service quality. Serv Bus. 2017;11(3):491-516. doi:10.1007/s11628-016-0317-2 DOI: https://doi.org/10.1007/s11628-016-0317-2
6. DelliFraine JL, Langabeer JR, Nembhard IM. Assessing the Evidence of Six Sigma and Lean in the Health Care Industry. Qual Manag Health Care. 2010;19(3):211-225. doi:10.1097/QMH.0b013e3181eb140e DOI: https://doi.org/10.1097/QMH.0b013e3181eb140e
7. Agarwal S, Gallo JJ, Parashar A, et al. Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency. Cardiovasc Revascularization Med. 2016;17(2):95-101. doi:10.1016/j.carrev.2015.12.011 DOI: https://doi.org/10.1016/j.carrev.2015.12.011
8. D’Andreamatteo A, Ianni L, Lega F, Sargiacomo M. Lean in healthcare: A comprehensive review. Health Policy (New York). 2015;119(9):1197-1209. doi:10.1016/j.healthpol.2015.02.002 DOI: https://doi.org/10.1016/j.healthpol.2015.02.002
9. Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Aff. 2011;30(3):464-471. doi:10.1377/hlthaff.2011.0178 DOI: https://doi.org/10.1377/hlthaff.2011.0178
10. Chaudhry B, Wang J, Wu S, et al. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. Ann Intern Med. 2006;144(10):742-752. doi:10.7326/0003-4819-144-10-200605160-00125 DOI: https://doi.org/10.7326/0003-4819-144-10-200605160-00125
11. Black AD, Car J, Pagliari C, et al. The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. Djulbegovic B, ed. PLoS Med. 2011;8(1):e1000387. doi:10.1371/journal.pmed.1000387 DOI: https://doi.org/10.1371/journal.pmed.1000387
12. Braithwaite J, Clay-Williams R, Taylor N, et al. Bending the quality curve. Int J Qual Heal Care. 2020;32(Supplement_1):1-7. doi:10.1093/intqhc/mzz102 DOI: https://doi.org/10.1093/intqhc/mzz102
13. Alkhenizan A, Shaw C. Impact of Accreditation on the Quality of Healthcare Services: A Systematic Review of the Literature. Ann Saudi Med. 2011;31(4):407-416. doi:10.4103/0256-4947.83204 DOI: https://doi.org/10.4103/0256-4947.83204
14. Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient‐centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs. 2013;69(1):4-15. doi:10.1111/j.1365-2648.2012.06064.x DOI: https://doi.org/10.1111/j.1365-2648.2012.06064.x
15. Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Heal Care. 2011;23(5):510-515. doi:10.1093/intqhc/mzr024 DOI: https://doi.org/10.1093/intqhc/mzr024
16. Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. Published online September 18, 2013:bmjqs-2012-001748. doi:10.1136/bmjqs-2012-001748 DOI: https://doi.org/10.1136/bmjqs-2012-001748
17. Ho PM, Bryson CL, Rumsfeld JS. Medication Adherence. Circulation. 2009;119(23):3028-3035. doi:10.1161/CIRCULATIONAHA.108.768986 DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.768986
18. Classen DC, Resar R, Griffin F, et al. ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. Health Aff. 2011;30(4):581-589. doi:10.1377/hlthaff.2011.0190 DOI: https://doi.org/10.1377/hlthaff.2011.0190
19. Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of Safety Climate and Safety Performance in Hospitals. Health Serv Res. 2009;44(2p1):399-421. doi:10.1111/j.1475-6773.2008.00918.x DOI: https://doi.org/10.1111/j.1475-6773.2008.00918.x
20. Murff HJ, FitzHenry F, Matheny ME, et al. Automated Identification of Postoperative Complications Within an Electronic Medical Record Using Natural Language Processing. JAMA. 2011;306(8). doi:10.1001/jama.2011.1204 DOI: https://doi.org/10.1001/jama.2011.1204
21. Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring Relationships Between Hospital Patient Safety Culture and Adverse Events. J Patient Saf. 2010;6(4):226-232. doi:10.1097/PTS.0b013e3181fd1a00 DOI: https://doi.org/10.1097/PTS.0b013e3181fd1a00
22. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol. 2015;5. doi:10.3389/fpsyg.2014.01573 DOI: https://doi.org/10.3389/fpsyg.2014.01573
23. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The Relationship between Patients’ Perception of Care and Measures of Hospital Quality and Safety. Health Serv Res. 2010;45(4):1024-1040. doi:10.1111/j.1475-6773.2010.01122.x DOI: https://doi.org/10.1111/j.1475-6773.2010.01122.x
24. Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71(4):1106-1117. doi:10.1093/jac/dkv418 DOI: https://doi.org/10.1093/jac/dkv418
25. Januel JM, Chen G, Ruffieux C, et al. Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis. JAMA. 2012;307(3). doi:10.1001/jama.2011.2029 DOI: https://doi.org/10.1001/jama.2011.2029
26. Silber JH, Romano PS, Rosen AK, Wang Y, Even-Shoshan O, Volpp KG. Failure-to-rescue: comparing definitions to measure quality of care. Med Care. 2007;45(10):918-925. doi:10.1097/MLR.0b013e31812e01cc DOI: https://doi.org/10.1097/MLR.0b013e31812e01cc
27. Hanefeld J, Powell-jackson T, Balabanova D. Understanding and measuring quality of care : dealing with complexity. 2017;(January):368-374. DOI: https://doi.org/10.2471/BLT.16.179309
28. Mainz JAN. Defining and classifying clinical indicators for quality improvement. 2003;15(6):523-530. DOI: https://doi.org/10.1093/intqhc/mzg081
29. Bates DW, Hospital W, Saria S. Big Data in Health Care : Using Analytics to Identify and Manage High-Risk and High-Cost Patients At the Intersection of Health , Health Care and Policy Cite this article as : David W . Bates , Suchi Saria , Lucila Ohno-Machado , Anand Shah and Gabriel Es. 2014;(July). doi:10.1377/hlthaff.2014.0041
30. Romano PS, Mull HJ, Rivard PE, et al. Validity of Selected AHRQ Patient Safety Indicators Based on VA National Surgical Quality Improvement Program Data. Health Serv Res. Published online 2008:182-204. doi:10.1111/j.1475-6773.2008.00905.x DOI: https://doi.org/10.1111/j.1475-6773.2008.00905.x
31. Bratzler DW, Hunt DR. The Surgical Infection Prevention and Surgical Care Improvement Projects : National Initiatives to Improve Outcomes for Patients Having Surgery. 2016;(May). doi:10.1086/505220 DOI: https://doi.org/10.1086/505220
32. Ramanathan R, Leavell P, Wolfe LG, Duane TM. Agency for Healthcare Research and Quality patient safety indicators and mortality in surgical patients. Am Surg. 2014;80(8):801-804. http://www.ncbi.nlm.nih.gov/pubmed/25105402 DOI: https://doi.org/10.1177/000313481408000832
33. Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13(1):211. doi:10.1186/1472-6963-13-211 DOI: https://doi.org/10.1186/1472-6963-13-211
34. Desai NR, Ross JS, Kwon JY, et al. Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA. 2016;316(24):2647. doi:10.1001/jama.2016.18533 DOI: https://doi.org/10.1001/jama.2016.18533
35. Kaafarani HMA, Borzecki AM, Itani KMF, et al. Validity of Selected Patient Safety Indicators: Opportunities and Concerns. J Am Coll Surg. 2011;212(6):924-934. doi:10.1016/j.jamcollsurg.2010.07.007 DOI: https://doi.org/10.1016/j.jamcollsurg.2010.07.007
36. Sousa P, Uva AS, Serranheira F, Uva MS, Nunes C. Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retrospective cohort study. Int J Qual Heal Care. 2018;30(2):132-137. doi:10.1093/intqhc/mzx190 DOI: https://doi.org/10.1093/intqhc/mzx190
37. Abbott P. Patient-centred health care for people with chronic skin conditions. Br J Dermatol. 2017;177(2):329-330. doi:10.1111/bjd.15709 DOI: https://doi.org/10.1111/bjd.15709
38. Bates DW, Saria S, Ohno-Machado L, Shah A, Escobar G. Big Data In Health Care: Using Analytics To Identify And Manage High-Risk And High-Cost Patients. Health Aff. 2014;33(7):1123-1131. doi:10.1377/hlthaff.2014.0041 DOI: https://doi.org/10.1377/hlthaff.2014.0041
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