From measuring transport to measuring care

The function of the ambulance service is changing from one of transportation to one of care, but quality indicators corresponding to the change in function are lacking in the Netherlands, prompting the following research question: ‘What are suitable quality indicators for ambulance service in the Netherlands?’ A suitable indicator aligns with the definition of ambulance service quality, has as many advantages as possible, has as few disadvantages as possible and is preferably evidence based. The definition for quality of ambulance service, translated to the Dutch context, is _the degree to which ambulance service, both transport and care, for individuals and populations is consistent with current professional knowledge and minimises mortality and morbidity_. International literature describes 69 quality indicators for ambulance service. Together with four categorisations, quality indicators define seven aspects of ambulance service quality: ‘organisation’, ‘staff’, ‘material facilities’, ‘care provision’, ‘documents & protocols’, ‘adverse events’ and ‘patient outcomes’. Since this research concerns thoughts and opinions, qualitative methods have been used. Data is collected using a literature review, document analysis, semi-structured interviews and observations. Currently in the Netherlands, seven indicators are implemented and two are used: patient satisfaction and response time. The respondents define five facets of quality of ambulance service: being ‘patient centred’, ‘patient experience’, ‘skilled staff’, ‘equipment’ and ‘transportation’. They want to measure quality through patient satisfaction, prior education accreditation and assessment, amount of restricted procedures performed, the driver style, social skills of nurses and drivers, rate of non-emergency calls and collaboration with the care chain. The disadvantages of quality indicators that the respondents see are administrative burden, decoupling, distrust, injustice and waste of resources. The advantages are benchmarking, improvement of care and practice-based evidence. The only aspect that science, policy and clinical practice agree upon is patient outcomes, with patient satisfaction as a quality indicator. Five indicators are mentioned in the international literature and by ambulance nurses, drivers, managers and policy advisors: rate of non-emergency calls, prior education, accreditation, assessment of ambulance personnel and patient satisfaction. These indicators correspond with three of the seven aspects of quality: ‘organisation’, ‘staff’ and ‘patient outcomes’. This set forms a promising starting point for a process of defining suitable quality indicators in the Dutch ambulance service context, measuring the key concepts of quality, that are evidence based and applicable in practice.