Measuring what matters: Strengthening healthcare quality assessment in Malaysia using Analytic Network Process
1
Centre for Health Quality Research (CHQR), Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Malaysia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Measuring healthcare quality is inherently complex due to the interdependence of multiple factors. Hence, reliable and standardised measurement is essential for evaluating performance and guiding quality improvement. This study aimed to measure healthcare quality performance in Malaysia based on prioritised indicators mapped across seven local quality domains: Safe, Timely, Effective, Efficient, Equitable, People-centred, and Accessible (STEEEPA).
METHODS:
Prioritised healthcare quality indicators identified through a modified Delphi process were organised into a composite measurement model using the Analytic Network Process (ANP), a multi-criteria decision-making approach that accounts for relationships among domains and indicators. Pairwise comparisons by Ministry of Health experts were conducted to derive priority weights for each domain and indicator. Consistency ratios satisfied accepted thresholds (CR <0.1). A weighted supermatrix was computed and normalised to derive the indicator’s final weights. These weights were then integrated into 2023 and 2024 national routine performance data to compute a national-level composite index for each domain, enabling national performance assessment. In the composite index, a score of 1 represented the benchmark for achieving the standard.
RESULTS:
Timely, Effective, People-centred, and Accessible domains were close to meeting the standards in both years. Safe, Effective, and People-centred domains showed improvement in 2024 compared to 2023. Equitable domain was not measured due to the limited availability of standardised national data to support a robust assessment.
CONCLUSIONS:
The ANP-based composite index provides policymakers with a systematic tool to compare performance across levels and guide areas for improvement in the measurement, contributing to more sustainable health systems. Although the exclusion of the Equitable domain limits a fully comprehensive national assessment, this reflects a data gap rather than a lack of relevant indicators. Prioritising the identification and development of suitable, data-informed indicators is therefore essential to strengthen the health system and support targeted improvements in service delivery.
Measuring healthcare quality is inherently complex due to the interdependence of multiple factors. Hence, reliable and standardised measurement is essential for evaluating performance and guiding quality improvement. This study aimed to measure healthcare quality performance in Malaysia based on prioritised indicators mapped across seven local quality domains: Safe, Timely, Effective, Efficient, Equitable, People-centred, and Accessible (STEEEPA).
METHODS:
Prioritised healthcare quality indicators identified through a modified Delphi process were organised into a composite measurement model using the Analytic Network Process (ANP), a multi-criteria decision-making approach that accounts for relationships among domains and indicators. Pairwise comparisons by Ministry of Health experts were conducted to derive priority weights for each domain and indicator. Consistency ratios satisfied accepted thresholds (CR <0.1). A weighted supermatrix was computed and normalised to derive the indicator’s final weights. These weights were then integrated into 2023 and 2024 national routine performance data to compute a national-level composite index for each domain, enabling national performance assessment. In the composite index, a score of 1 represented the benchmark for achieving the standard.
RESULTS:
Timely, Effective, People-centred, and Accessible domains were close to meeting the standards in both years. Safe, Effective, and People-centred domains showed improvement in 2024 compared to 2023. Equitable domain was not measured due to the limited availability of standardised national data to support a robust assessment.
CONCLUSIONS:
The ANP-based composite index provides policymakers with a systematic tool to compare performance across levels and guide areas for improvement in the measurement, contributing to more sustainable health systems. Although the exclusion of the Equitable domain limits a fully comprehensive national assessment, this reflects a data gap rather than a lack of relevant indicators. Prioritising the identification and development of suitable, data-informed indicators is therefore essential to strengthen the health system and support targeted improvements in service delivery.
| eISSN: | 2654-1459 |
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