Quality is a complex notion and means different things to different people. So before we challenge ourselves to improve quality, we need to define exactly what it means.
Our definition of quality is essentially very simple; we see it as the ‘degree of excellence’ in healthcare.
Of course, excellence has many dimensions. But within the sector it is widely accepted that excellent healthcare should have the following six characteristics1:
- Safe – avoiding harm to patients from care that is intended to help them.
- Effective – providing services based on scientific knowledge and which produce a clear benefit.
- Person-centred – providing care that is respectful or responsive to individuals’ needs and values.
- Timely – reducing waits and sometimes harmful delays.
- Efficient – avoiding waste.
- Equitable – providing care that does not vary in quality because of a person’s characteristics.
Often the dimensions are complementary. However, there are tensions among them that need to be balanced – for example, person-centredness may not always go hand-in-hand with efficiency.
What do we believe improves quality?
We have identified a number of solutions that have the greatest potential to make lasting and widespread improvement to health services:
- A sustained focus on continuous improvement in the quality of health services is needed.
- Emphasise the importance of internal motivators (for example, professionalism, skills development, organisational development and leadership), alongside external ones (for example, regulation, economic incentives and performance management).
- Align quality at every level to make sure that all levels of the system relate to each other in supporting quality.
- Redefine the nature of the relationship between people who use services and those who provide them.
- Build knowledge, skills and new practices, including learning from other sectors that have improved their performance and reliability in highly complex areas.
Read more about the challenges and solutions to high quality care
- Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press, 1990, p244.