Scale-Dependent Spatial Clustering of Hospital Operational Performance and Patient Safety Outcomes in East Java, Indonesia: A Spatial Autocorrelation Analysis

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Abstract
Understanding variations in hospitals’ operational performance and patient safety is critical for improving health system efficiency, particularly in decentralized healthcare systems such as that of Indonesia. While geographic disparities in health outcomes are often emphasized in research, the relative contribution of spatial patterns remains underexplored. Addressing this gap, this study analyzed data from 428 hospitals in East Java, Indonesia. Composite indices were developed to measure hospitals’ operational performance and patient safety outcomes using standardized indicators. Spatial autocorrelation was assessed using global and local Moran’s I at both hospital and district scales. The findings reveal no significant spatial clustering at the hospital level for either operational performance or patient safety outcomes. However, significant spatial clustering of patient safety outcomes emerged at the district level. Finally, the findings of local Moran’s I revealed the specific districts with high and low mortality rates. For policymakers, the implications are clear. Districts revealed as high mortality regions need to receive additional attention immediately. For example, best practices could be learned from districts where low mortality prevails.

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