Consideration(S) of the Consequential Effects of Quality Indicators for Sustainable Development in Health Care Practice and Delivery

Indicators play a major role in organizing, monitoring, and evaluating quality improvement in health care. They reflect the existing and desired level of service delivery, making it possible to define measures to achieve the desired level, monitoring their implementation and the success of the programme. The idea of the usefulness of accurate indicators in ensuring sustainable development is currently beyond doubt and acts as a paradigm (generally accepted truth) in the ideology of sustainable development. The purpose of this article is to demystify this paradigmatic status and draw attention to the important side effect of their use. It is the phenomenon of an alternative way to improve indicators (AWII) – identifying and using opportunities to improve indicators without improving the quality of medical services. The article discusses the prevalence of this phenomenon, its main types, the dependence of the type AWII on the characteristics of a used quality indicator, their role in distorting the link between quality indicator readings and actual quality, the conditions stimulating the use of AWII, and barriers that oppose its use. A system of measures aimed at the timely prevention of AWII is discussed.