Defining Healthcare Quality
"Quality is the standard of something when compared to other things like it; how good or bad something is."
The Complexity of Definition
According to Goldenberg (2012), there is no single, universally accepted definition of "quality of care." Definitions are often persuasive, meaning they reflect the values and priorities of the person or organization defining them (e.g., a patient vs. a hospital manager vs. a paramedic).
Dimensions of Quality (WHO/OECD)
High-quality healthcare must be:
- Effective: Providing evidence-based care to those who need it.
- Safe: Avoiding injuries to patients from the care that is intended to help them.
- People-Centred: Providing care that is respectful of individual preferences.
- Timely: Reducing waits and sometimes harmful delays.
- Equitable: Care that does not vary in quality because of personal characteristics (gender, ethnicity, location).
- Efficient: Avoiding waste (equipment, ideas, energy).
Donabedian’s Triad
A fundamental framework for assessing quality by looking at three categories of information.
1. Structure
The attributes of the setting where care occurs.
- Facilities & Equipment
- Staff qualifications
- Organizational protocols
2. Process
What is actually done in giving and receiving care.
- Patient assessment
- Clinical interventions
- Communication
3. Outcome
The effects of care on the health status of patients.
- Mortality/Morbidity rates
- Patient satisfaction
- Functional recovery
Assurance vs. Improvement
- Quality Assurance (QA): Focuses on meeting minimum standards and identifying outliers (Reactive).
- Quality Improvement (QI): Focuses on continuously raising the bar for the entire system (Proactive/Iterative).
The Science of Improvement
Improvement is not just "doing better"; it is a structured methodology combining multiple disciplines (sociology, psychology, engineering, epidemiology).
Deming’s System of Profound Knowledge (SoPK)
The theoretical foundation of improvement science consists of four pillars:
- Appreciation for a System: Understanding how all parts of an organization work together toward a goal.
- Knowledge of Variation: Distinguishing between common cause (inherent in the system) and special cause (external/unusual) variation.
- Theory of Knowledge: Learning through the use of models and predictions (e.g., PDSA cycles).
- Psychology: Understanding human behavior, motivation, and the culture of change.
7 Propositions of Improvement Science
Based on Perla, Provost, and Parry (2013).