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CSS Insurance

Questions & Answers

Are you looking for further information regarding the published data, the search results or the ranking? Most common questions will be covered here.

Information

How can I interpret the case numbers for individual locations and hospital groups?

All hospitals belonging to a network and using a single paying agent register no. (ZSR no.) appear in the hospital's detailed view showing the names of all the hospitals / locations (e.g. Lucerne Cantonal Hospital with locations in Wolhusen and Sursee). The displayed case numbers always refer to the entire hospital group and need to be interpreted accordingly. A high case number for the entire hospital group thus cannot be applied to the individual hospital.

Exceptions:

  • Insel Group (Berne): The medical centres that were previously part of Berne's hospital network are shown under the Insel Group; however, Inselspital (Bern University Hospital) is shown separately. The numbers must therefore be interpreted accordingly.
  • Hôpital Riviera-Chablais Vaud-Valais: In the case of this network there are several ZSR numbers, yet the same case numbers apply to all locations.

Hospitals belonging to a group that have their own ZSR no. are displayed separately (e.g. Asana Group with hospitals in Menziken and Leuggern).

Which quality indicators are shown and which ones not?

The published patient satisfaction indicators of CSS and ANQ, as well as the case numbers, wound infection rates, rehospitalisation rates, reoperation rates and pressure sores, differ in terms of their importance and interpretation. CSS and ANQ patient satisfaction figures reflect subjective findings on the quality of the treatment and results. Case numbers, wound infection rates, rehospitalisation rates, reoperation rates and pressure sores, on the other hand, objectively gauge the quality of treatment and results. In principle no information is provided on the quality of processes and organisational aspects, e.g. hospital facilities, training and development of staff, documentation of health histories, emergency and palliative care concepts, etc., as well as on disciplinary and interdisciplinary processes and circumstances.

For the sake of readability, the use of specialised language has been minimised to the extent possible. Only in cases where it makes good sense have specialised terms been added in brackets.

When is the information updated?

CSS updates its own information as soon as new findings become available. In future, publicly available information will be updated annually in the autumn or on receipt, provided the hospital has delivered its current information to the ANQ or published it in its quality report. Otherwise, the available information from the previous measurement year will be carried over.

Patient satisfaction CSS - 2015, 2016, 2017
Patient satisfaction ANQ - 2016
Pressure sores - 2016
Wound infection rates - 2016
Rehospitalisation rate - 2015
Reoperation rate - 2015
Additional quality information - 2017

Please note that CSS patient satisfaction surveys are generally conducted in different cycles. In other words, hospitals are surveyed on a staggered basis, depending on the level of care and services provided. Therefore, results may refer to different years.

Where does the information come from?

The published information on quality issues at Swiss acute hospitals comes from public sources (e.g. ANQ) and CSS's own surveys. It was subsequently adjusted and processed to make it easier to understand (e.g. by rounding up figures to two decimal points, calculating the average of all questions in a particular category, etc.).

Public sources include

  • information from the ANQ: Wound infections, pressure sores (decubitus) categories 1-4, as well as patient satisfaction surveys,
  • the quality report of H+: Reoperation and rehospitalisation rates,
  • the Federal Office of Public Health (FOPH): Case numbers.

CSS's own analyses include

  • the patient satisfaction survey, analysed by ValueQuest.

What is an acute hospital?

An acute hospital is a general medical centre in the classical sense that provides services relating to examinations, treatment and patient care. For now, QualiCheck shows only acute hospitals, because they make up the majority of all hospitals.

What is the ANQ?

ANQ stands for Association nationale pour le développement de la qualité dans les hôpitaux et les cliniques and is a national association for quality development in hospitals and clinics.

What is a quality report (also called "hospital report")?

This refers to a report that hospitals issue annually in accordance with the provisions of H+ and that gives a general overview of the hospital's quality measures. The report is available on spitalinformation.ch.

What is the BAG?

BAG (Federal Office of Public Health) is part of the Swiss Federal Department of the Interior and, together with the cantons, is responsible for public health in Switzerland and for developing the national health policy.

What are case numbers?

Case numbers show how many inpatient operations and treatments were performed in which hospital during a particular year. In principle it can be assumed that a high case number correlates with more experience and expertise and thus indicates a higher quality of treatment. However, when comparing hospitals it is important to consider the invariable effect of size on the case number (e.g. comparing a university hospital with a regional hospital). In addition, the treating physicians at a large hospital may vary, while in a small hospital the same doctor is likely to perform certain treatments or operations regularly.

Case numbers are analysed based on the information provided by the SwissDRG Swiss Diagnosis Related Groups), which refers to case groups. They form the basis of the Swiss hospitals' flat-rate-per-case system and are linked to diagnoses.

QualiCheck also offers summaries of similar and related operations and treatments – where doing so makes sense – so as to provide the general public with information that is meaningful in terms of scope and detail.

What is H+?

"H+ Die Spitäler der Schweiz" is an association of public and private hospitals, clinics and care institutions.

What is ValueQuest?

ValueQuest is a scientifically-based marketing research company that has been conducting patient satisfaction surveys for CSS for many years.

Search results / ranking

How are the search results sorted and displayed?

The ranking of the displayed hospitals is based on the case numbers. For example, if you are looking for a clinical picture without entering the place, canton or hospital in the text box, you will see the six hospitals (in declining order) with the highest case numbers from anywhere in Switzerland. Unless you enter a clinical picture in the text box, the case numbers shown in the search results field always refer to the whole hospital. If the case numbers of the displayed hospitals are the same, the ranking takes place alphabetically. In the compare hospitals view, you can also sort the values of the quality indicators in ascending and descending order.

Why does no information on quality appear for the hospital I selected? (Message "No information")

Possible reasons include:

  • The hospital has not conducted a survey,
  • the information is still being processed and is not yet available,
  • the ANQ has dispensed the hospital and it is thus exempt from the current measurement,
    the quality of the information is so low that it cannot be displayed,
  • the response rate is so low that the information cannot be displayed,
  • the hospital has explicitly asked not to publish the information, or refuses to do so in principle,
  • CSS has not yet conducted a patient satisfaction survey at this hospital,
    a current quality report is not yet available (see "When is the information updated?").

Why does the hospital I'm looking for have a different name?

The current name of the hospital is used. Differences may also arise because the hospital has become part of a group or changed its name. In case of doubt, we recommend that you search by location.

Why does the hospital I'm looking for not appear at all?

The hospital is either not an acute hospital (but a rehabilitation clinic, for example) or it has closed. Only quality indicators of hospitals in operation are shown.

Why are only these hospitals in the area shown and not other ones?

You start your search by entering the clinical picture and the location. However, if the location does not have a hospital nearby, the search is expanded until at least one hospital is found for which case numbers exist for the clinical picture you are querying.

Why is the highest positive decubitus rate shown in red, thus indicating a bad result?

Values of less than zero indicate that pressure sores occur less frequently than average for all hospitals. Values of more than zero indicate that pressure sores occur more frequently than average for all hospitals. "- 2" is therefore better than "-1", "-1" is better than "1", and "0" is average.

How does the mobile QualiCheck work?

The mobile version gives you all the functions of the desktop version, except for the map and the mannequins.

Quality indicators (CSS's own and public)

Patient satisfaction survey

What is the background to CSS's own survey, and which key figures and information from the patient satisfaction survey are shown?

CSS has been surveying its insured persons about their general satisfaction with treatments and stays at acute hospitals since August 2014. The survey is conducted in intervals and involves insured persons above age 18 from all acute hospitals with stays dating back not more than three months prior to the survey. An insured person will be asked about such a stay not more than once during any particular year.
When interpreting the results, please note that hospitals which are part of a network (e.g. Lucerne Cantonal Hospital with locations in Lucerne, Wolhusen and Sursee) are surveyed together as a network. This means that the data shown for individual locations reflects the overall results for the network as a whole (similar to the case numbers). In addition, we would like to point out that the values have not been risk adjusted.
In other words, a lower patient satisfaction rating is not necessarily the same as a poorer result in terms of quality. Adjusting risk aspects to the quality indicators means that patient-related factors such as age, length of stay, prior illnesses, as well as differences in the distribution of these risks (patient mix) among the hospitals is also factored into the calculation.

The complete CSS questionnaire includes 26 categories, whereby one category can contain several questions. The values that are displayed for "Doctors" (seven questions), "Nursing staff" (five questions), "Amenities" (four questions) and "Catering" (four questions) are averages derived from the responses. You will find details on the various categories and questions in the patient satisfaction questionnaire. The number of displayed responses may vary because incomplete questionnaires were analysed as well (e.g. ones with only four responses in a five-question category). The scale of 1-6 (same as is used in Swiss schools) has 1 as the poorest rating ("not at all") and 6 as the best rating ("fully"). Questions with "Don't know " responses were not included in the calculation.

We generally achieve good response rates with our surveys. At the same time, not all hospitals provided us with a large number of evaluations. This is because not all places had the same number of persons insured with CSS who received treatment.

What is the background to the ANQ survey, and what information is shown?

Every year in September, ANQ conducts a patient satisfaction survey. The target group includes adult patients above the age of 18 whose hospital stay ends in September (duration of more than 24 hours). The satisfaction survey is administered 2 – 7 weeks after the patients are discharged
and includes six question with a range of possible answers. For the first five questions, the respondent must choose between 1 (most negative) and 5 (most positive); for the sixth question the respondent must choose between 1 (too short) and 3 (too long). Based on these response options, QualiCheck shows only the average of the first five questions as the result. The average comprises all the questions, weighted equally, for the location.

The current questions of the ANQ patient satisfaction survey in acute hospitals are:

  1. How do you rate the quality of the treatment you received from the doctors and nurses?
  2. Were you given the possibility to ask questions?
  3. Did you receive satisfactory answers to your questions?
  4. Did you receive satisfactory explanations about the purpose of the medication you were supposed to take at home?
  5. How well was your discharge organised?
  6. What do you think about the length of your hospital stay?

The ANQ generally aims to record and compare the results of the satisfaction survey throughout the country. For this, it is necessary to adjust the risk in all of the measurement results. In the field of acute somatics, the risk is also adjusted by using the person's age, gender and location after discharge.

We would like to point out that hospitals with fewer than 50 valid questionnaires are excluded from the survey.

Read more about the ANQ patient satisfaction survey

Further public metrics

What is a pressure sore indicator?

A pressure sore (decubitus) is a skin injury that also affects the tissue underneath. A possible cause is inadequate or incorrect care (e.g. incorrect positioning of the patient), which is why frequency rates and pressure sore size are indicative of the quality of the care being administered. The values for categories 1-4 shown here (all types of pressure sores, including light and severe cases) relate to the hospital as a whole and not to a specific clinical picture. This indicator is particularly relevant for patients facing an extended hospital stay or who are at greater risk of developing a pressure sore. 

How is the pressure sore indicator measured and interpreted?

The measurement takes place on a certain day of the year (prevalence measurement), and the results are shown as a risk-adjusted residual value (the calculated value for the hospital). This means that patient-relevant factors such as age, length of stay, or prior illnesses are also factored into the calculation. Values of less than zero indicate that pressure sores occur less frequently than average for all hospitals; in the case of values of more than zero, they occur at above-average frequency. "- 2" is therefore better than "-1", "-1" is better than "1", and "0" is average. On the compare hospital page, the best value is shown in green and the worst value is shown in red.

Please note that the date causes a distortion when comparing values because not all patient groups can be considered on a single day.

What is the rehospitalisation rate?

This indicator (see ANQ) measures the quality of the preparation of a patient's discharge from hospital. The rate shown in QualiCheck is the internally observed rate (as observed in a particular hospital) taken from the currently available quality report of the hospital. It is calculated based on the portion of applicable stays that could result in potentially avoidable cases of rehospitalisation. Rehospitalisation is seen as potentially avoidable if:

  • The case relates to a diagnosis during a previous hospital stay,
  • could not have been foreseen when the person was discharged at the time,
  • and set in within 30 days from when the person was discharged.

The calculation includes all inpatients, also children. The calculation does not include:

  • Deceased patients or those who transferred to another hospital,
  • healthy newborns,
  • day-case surgery patients, and
  • patients whose place of residence is abroad.

What is the reoperation rate?

This measurement (see ANQ) serves to monitor the frequency of surgical complications with the aim of improving the treatment quality. The observed rate displayed in QualiCheck is derived from the hospital's currently available quality report. It is calculated based on the portion of surgical procedures that could result in potentially avoidable cases of reoperation. Cases are deemed to be potentially avoidable if:

  • They involve surgery of the same anatomical place and could not have been foreseen, and
  • can be attributed to an unsuccessful procedure or to postoperative complications – and not to a worsening of the basic illness

What is the wound infection rate?

A postoperative wound infection refers to a condition that sets in and affects the treated body part or organ within one month, or 12 months in the case of defined types of surgery, after the operation. The displayed risk-adjusted wound infection rate refers to the entire hospital and includes all infection types, i.e. both superficial ones and those that occur deep within organs or cavities. Adjusting risk aspects to the quality indicators means that patient-related factors such as age, length of stay, prior illnesses, as well as differences in the distribution of these risks (patient mix) among the hospitals is also factored into the calculation.

All hospitals affiliated with the ANQ are obliged to participate in the measurement. Out of a total of ten index operations, two are voluntary; out of the remaining eight, three must be selected and included in the measurement. All hospitals whose services include surgery of the large intestine are obliged to carry out this wound infection measurement.

QualiCheck gives you the wound infection rates in the detailed view of the hospital. To enable you to compare hospitals in terms of a selected clinical picture (e.g. digestive tract), we chose to show what we believe is the most frequently measured or occurring wound infection rate (the large intestine in this case). In addition, the available wound infection rates are shown in the blue box once you have selected a clinical picture. The detailed view of the hospital provides an overview of all the measured and displayed wound infection rates.