Open Access Open Badges Research article

The development of quality indicators in mental healthcare: a discrete choice experiment

Ron Schellings1, Brigitte AB Essers2*, Alfons G Kessels23, Florian Brunner4, Tijmen van de Ven1 and Paul BM Robben15

Author Affiliations

1 Health Care Inspectorate; Ministry of Health, Welfare, and Sports, Den Bosch, The Netherlands

2 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands

3 Horten Centre, Zürich University, Zürich, Switzerland

4 Department of Physical Medicine and Rehabilitation, Balgrist University Clinic, Zürich, Switzerland

5 Institute of Healthcare Policy & Management, Erasmus University, Rotterdam, the Netherlands

For all author emails, please log on.

BMC Psychiatry 2012, 12:103  doi:10.1186/1471-244X-12-103

Published: 7 August 2012



Health care regulatory agencies perform audits or inspections to judge the quality and safety of health care. This judgment is based on the assessment of a large set of health care indicators as accepted by the profession. However, there is a lack of knowledge about the influence of these indicators and whether a smaller number would be sufficient for a quality assessment or audit procedure.


A discrete choice experiment (DCE) was performed for the assessment of quality of care regarding the management of patients with schizophrenia and drug dependency in psychiatric institutes. Based on multidisciplinary guidelines for the treatment of schizophrenia and a visit of (co)inspectors of the Dutch Healthcare Inspectorate at all 33 integrated mental hospitals a set of 51 indicators were assessed in a subsequent interview. With the analysis of the results, 6 attributes were selected for the DCE as quality indicators.


Seventy-six percent of all health services (co)inspectors (n = 33) involved in the inspection of mental health services, participated in the experiment. Respondents considered an operational elaborate treatment plan the most important indicator for the assessment of quality of care in a psychiatric institute, followed by a general care program, treatment outcome measurement, and involvement in treatment of patients and relatives. Pharmacotherapy and governance responsibility were valued as less important indicators.


The results of this DCE show that there is a prioritisation in the six selected quality indicators. This might help health services (co) inspectors to enhance the efficiency and transparency of the quality of care assessment for patients with schizophrenia and/or drug dependency in psychiatric institutes.

Discrete choice experiment; Healthcare regulatory agencies; Quality indicators; Mental healthcare; Quality of care