Perspectives of Patients and other Stakeholders on Healthcare Quality in Ophthalmology

The use of rankings is common within healthcare. Newspapers, for example, publish rankings of hospitals, ranking them from best to worst. This may lead to indignation about why one hospital is ranked higher than another, as criteria for ranking are often unclear and subject to debate. Some have referred to `hospital rankings´ as `oliebollen-lijstjes`, rankings of ‘deep-fried raisin buns’, a typical Dutch snack that is traditionally consumed in the Netherlands on the last day of the year. Over the past decennia, a ranking of the best ‘oliebol’ was published by a daily Dutch newspaper in December. The ranking was more and more criticized over the years, despite continues efforts of the newspaper to improve on objectivity, validity and transparency. A few years ago, as a result of the
continuous criticism, the newspaper finally gave up on the annual tradition and stopped publishing the ranking. However despite being criticized as well, rankings continue in the healthcare domain. This suggests that we cannot give up on defining, comparing and improving quality of care, despite the complexity of the task and despite that the validity of such ranking is disputed. If indeed we want to proceed with rankings of health care facilities, we need to advance our understanding in the interest of patients and all other stakeholders involved. These thoughts and ambitions gave rise to this thesis, which identifies, analyses and integrates various perspectives on quality of care.