• Logo
  • SBMUJournals

International Hospital Performance Assessment: Developing a Questionnaire

Mona Mohammadnia, Kamran Hajinabi, Mahmoud Mahmoudi Majd Abadi Farahani, Ali Komeli




Background: As there is no valid questionnaire for assessing international hospital performance from providers’ perspective, this study aimed to develop a reliable as well as valid questionnaire for Iranian hospitals.

Materials and Methods: To develop the International Hospital Performance Assessment (IHPA) questionnaire, literature review did and comparative study conducted for extracting relevant items from twenty leader hospitals in all over the world. After that, to design the questionnaire and estimate its content validity index and ratio (CVI, CVR), 20 medical tourism experts selected. Then, questionnaire‘s construct validity (CVI & CVR) determined by using SPSS version 21 as well as exploratory factor analysis. Finally, reliability assessed by calculating Cronbach’s alpha coefficient.

Results: The content validity of the questionnaire determined as (CVI= 0.85, CVR= 0.60). According to expert opinion 5 dimensions of the questionnaire selected from World Health Organization hospital performance framework, which were clinical effectiveness and patient safety, efficiency, patient centeredness, governance responsiveness and even staff orientation. Furthermore, results of exploratory factor analysis showed that the questionnaire contained 45 items and Cronbach’s alpha coefficient was 0.687.

Conclusion: Results indicated that standard IHPA questionnaire with 45 items in 5 dimensions developed as a tool for measuring hospitals’ quality of care in Iran.


Hospitals, Questionnaire, Medical tourism


Carrera P, Bridges J. Globalization and healthcare: understanding health and medical tourism. Expert Review Pharmacoeconomics Outcomes Results. 2006;6(4):447-54.

Siddiqi S, Shennawy A, Mirza Z, Drager N, Sabri B. Assessing trade in health services in countries of the Eastern Mediterranean from a public health perspective. Intl J Health Plann. Manage. 2010;25(3):231-50.

Woodhead A. Scoping medical tourism and international hospital accreditation growth. IJHCQA. 2013;26(8):688-702.

Brubakk K, Vist E G, Bukholm G, Barach P, Tjomsland O. A systematic Review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Services Research. 2015;15(280):1-10.

Delgoshaei B, Ravaghi H, Abolhassani N. Importance-performance analysis of medical tourism in Iran from medical tourists and medical services providers’ perspective: 2011. Medical Journal of Scientific Research. 2012;12(11):1541-7.

WWW.MTQUA.ORG (accessed on 22/03/2018)

vct.iums.ac.ir/uploads/aeen_name_zavabet.pdf (2018; accessed on 22/03/2018) [Persian]

Ziasheikholeslami N, Rezaeian M, Bahsoun M, Taghipoor M. Medical tourism: the view of Rafsanjan Medical University staff. Iranian Journal of Epidemiology. 2010;5(4):31-6.

Mc Kee M, Healy J, eds. Pressures for Change. In Hospitals in a Changing Europe. Buckingham: Open University. 2002;49.

Veillard J, Champagne F, Klazinga N,et al. A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. Int J Qual Health Care. 2005;17:487-96.

Queensland government. Hospital and Health Service Performance Management Framework,http://www.visiondiweb.com/insight/lecturas/Hospital_and_Health_Service.pdf (2015, accessed 30 August 2017).

Lim Ch, Tang NK. A study of patients’ expectations and satisfaction in Singapore hospitals. Int J Health Care Qual Assur. 2000;13(7):290-9

Tucker JL, Adams SR. Incorporating patients’ assessment of satisfaction and quality: an integrative model of patients’ evaluations of their care. Managing Service Quality: An international journal. 2001;11(4):272-87.

Jabnoun N, Chaker M. Comparing the quality of private and public hospitals. Managing Service Quality: An international Journal. 2003;13(4):290-9.

Sohail M. Service quality in hospitals: more favorable than you might think. Managing Service Quality: An international Journal. 2003;13(3):197-206.

Boshoff C, Gray B. The relationship between service quality, customer satisfaction and buying intentions in the private hospital industry. South African Journal of Business Management. 2004;35(4).

Qolipour M, Torabipour A, Faraji Khiavi F, Saki Malehi A. Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals. Electronic Physician. 2017;9(3):3905-3911.

Lawshe Ch. A quantitative approach to content validity1. Personnel psychology. 1975;28(4):563-75.

Polit DF, Beck CT & Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67.

Wynd CA, Schmidt B & Schaefer MA. Two quantitative approaches for estimating content validity. West J Nurs Res. 2003;25(5):508-18.

Prakash S, Pallepati A. Cross-cultural content validation of a modified service quality questionnaire in Kannada. J Indian Assoc Public Health Dent. 2016;14(2):17.

Saw SM, Ng TP. The design and assessment of questionnaires in clinical research. Singapore Medical Journal. 2001;42(3):131-5.

Ajmera P, Satia HK, Mahavir Singh MG. Development of a reliable and valid questionnaire considering Indian hospitals’ perspective of globalization of health in context to India. International Journal of Engineering Research and General Science. 2015;3(1):764-77.

Faraji Khiavi F, Qolipour M, Dashtinejad Z, Mirr I. Determination of Dimensions and Items of Outpatient Service Quality for Ahvaz Hospitals. Journal of Payavard Salamat. 2018;11(5):490-500.

Osborne JW, Costello AB. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pan-Pacific Management Review. 2009;12(2):131-46.

DOI: https://doi.org/10.22037/nbm.v6i3.20813