Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review
Open accessAbstract
OBJECTIVE: Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. METHODOLOGY AND MAIN FINDING: Three electronic data bases were searched over a 30 years period (1978-2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. CONCLUSION: The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.
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According to Boulkedid et al. (2011), heterogeneity in Delphi leads to better performance of the overall performance and enriches the results.
“According to Boulkedid et al. (2011), heterogeneity in Delphi leads to better performance of the overall performance and enriches the results.”
From A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium (2017) · cites this paper as Boulkedid et al. (2011)
The Discussion section, “A Heterogeneous Panel Member” (page not provided), says heterogeneity in a decision-making group may lead to better performance and that differing stakeholder viewpoints enrich Delphi results. The claim overstates the first point as a definite effect rather than a possibility. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBoulkedid et al. advise a nine-point Likert scale as the preferred choice in the development of quality indicators in care.
“Boulkedid et al. (2011) advise this scale as the preferred choice in the development of quality indicators in care.”
From A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium (2017) · cites this paper as Boulkedid et al. (2011)
By choosing participants based on their willingness to participate, their knowledge on the topic and by explaining them the purpose and the importance of their participation explicitly, the response-rate was optimised.
“By choosing participants based on their willingness to participate, their knowledge on the topic and by explaining them the purpose and the importance of their participation explicitly, the response- rate was optimised (Boulkedid et al., 2011).”
From A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium (2017) · cites this paper as Boulkedid et al., 2011
The Delphi method is a well-established semi-structured approach to working toward consensus among experts.
“To develop and refine some ethical principles to guide application of the PERCS framework, we used the Delphi method—a well-established semi-structured approach to working toward consensus among experts (41).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [41]
The guideline update used a modified Delphi approach.
“Guideline development used a modified Delphi approach.”
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“6,22,23 In practice, it involves selecting a panel of experts who anonymously respond to structured questionnaires across multiple rounds.”
- Authors
- Boulkedid, R., Abdoul, H., Loustau, M., Sibony, O., & Alberti, C.
- Affiliations
- Inserm (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Boulkedid, Rym
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-06-09
- Volume
- 6
- Issue
- 6
- Pages
- e20476
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3111406
- OpenAlex
- W2147072925
- Cited by
- 2,045
- References
- 54
- Citations by year
- 2026: 204 · 2025: 228 · 2024: 227 · 2023: 212 · 2022: 218 · 2021: 220 · 2020: 195 · 2019: 147 · 2018: 121 · 2017: 73 · 2016: 71 · 2015: 48 · 2014: 40 · 2013: 23 · 2012: 15
- FWCI
- 13.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Social Sciences › Education › Health Education and Validation
- Keywords
- Delphi method, health care quality indicators, reporting quality, expert panel, consensus building, response rate, stakeholder engagement
- MeSH terms
- Delphi Technique, Humans, Research Design, Guidelines as Topic, Quality Indicators, Health Care
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