Hospital effectiveness from administrative data: the Lombardy case Pietro Giorgio Lovaglio CRISP and Department of Quantitative Methods for Business Economic Sciences, University of Bicocca-Milan, Milan, Italy Abstract Purpose – The aim of this paper is the discussion and the dissemination of initiatives promoted by the Lombardy region for the construction of benchmarking systems between regional health structures of care utilizing administrative archives. Design/methodology/approach – The paper focuses on relative effectiveness (specific effect of care on patients) in a benchmarking framework, considering the dimension of sentinel outcomes. From Lombardy Hospital Discharge Cards proxies of sentinel outcomes are identified, defined as “context indicators” useful for a benchmarking analysis. Findings – First, the authors present outcomes and covariates at different levels (patient and healthcare structure) extracted from the Lombardy Hospital Discharge Cards for a benchmarking analysis. Second, empirical results show a consistent quota of outcome variability between structures of care and weak agreement between estimated rankings for context indicators. Finally, a slicing approach is suggested in order to apply an equitable comparison among healthcare structures. Practical implications – The paper provides regional stakeholders with practical implications regarding available strategies (outcomes, statistical methodology, risk adjustment) for consistent processes of evaluation, in a benchmarking framework, based on existing regional administrative data. Originality/value – After having presented available information contained in regional archives for a benchmark analysis, empirical results were discussed about context indicators, presenting indications and strategies for a refinement of the approach. From a methodological point of view, the utilization of multilevel models (improving methodological strategies adopted by international agencies) in large administrative databases is proposed. Keywords Hospital management, Benchmarking, Business administration Paper type Research paper 1. Introduction In recent years, there has been increasing attention directed toward the problems inherent to Quality Control in the Healthcare Services. Several factors have brought about this increased interest in the quality of the operational aspects of the Healthcare field. First of all, the Healthcare system has been going through a transition from a reimbursement system where the resources were assigned to structures independently of how they were used, to one where such allocation is distributed according to prefixed figures for different pathology. The amount of resources used to cure patients having a given pathology is deduced by means of the Diagnostic Related Group system (DRG). The system, based on the DRG, has the disadvantage of inducing hospitals to place a higher priority on economic aspects instead of the necessity of effective care. The current issue and full text archive of this journal is available at www.emeraldinsight.com/1754-2731.htm TQM 22,5 474 Received August 2008 Revised March 2009 Accepted March 2009 The TQM Journal Vol. 22 No. 5, 2010 pp. 474-486 q Emerald Group Publishing Limited 1754-2731 DOI 10.1108/17542731011072829