Quality of care should be defined in light of both technical standards and patients' expectations. While no single definition of health service quality applies in all situations, the following common definitions are helpful guides:

    Quality Assurance is that set of activities that are carried out to monitor and improve performance so that the care provided is as effective and as safe as possible.

    The application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits.

    Proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition .

The most comprehensive and perhaps the simplest definition of quality is that used by advocates of total quality management.”Doing the right thing right, right away." Experts generally recognize several distinct dimensions of quality that vary in importance depending on the context in which a QA effort takes place. The following nine dimensions of quality have been developed from the technical literature on quality and synthesize ideas from various QA experts. Together, they provide a useful framework that helps health teams to define, analyze, and measure the extent to which they are meeting program standards for clinical care and for management services that support service delivery. While all of these dimensions are relevant to developing country settings, not all nine deserve equal weight in every program. Each should be defined according to the local context and specific programs.

    Technical performance: The degree to which the tasks carried out by health workers and facilities meet expectations of technical quality.

    Access to services: The degree to which healthcare services are unrestricted by geographic, economic, social, organizational, or linguistic barriers

    Effectiveness of care: The degree to which desired results (outcomes) of care are achieved

    Efficiency of service delivery: The ratio of the outputs of services to the associated costs of producing those services

    Interpersonal relations: Trust, respect, confidentiality, courtesy, responsiveness, empathy, effective listening, and communication between providers and clients

    Continuity of services: Delivery of care by the same healthcare provider throughout the course of care (when appropriate) and appropriate and timely referral and communication between providers

    Safety: The degree to which the risks of injury, infection, or other harmful side effect are minimized

    Physical infrastructure and comfort: The physical appearance of the facility, cleanliness, comfort, privacy, and other aspects that is important to clients

    Choice: As appropriate and feasible, client choice of provider, insurance plan, or treatment

The Dimensions of Quality

Reading Assignment:

    Download and read Chapter 2 in Essentials of Quality with Cases and Experiential Exercises.  Review the Discussion Questions at the end of the chapter to be sure that you understand what you have read.

    Supplementary Readings:

Discussion -- Operational zing the Dimensions of Quality:

    Garvin's 8 dimensions of product quality provide a good conceptual framework for understanding the multidimensional nature of product quality. But to actually use the dimensions to measure the quality of a particular product, the dimensions must be operational zed -- that is measureable characteristics (metrics) must be defined which enable an assessment of the dimension they represent.  For example, you cannot measure the performance of an automobile directly.  You have to develop metrics for performance.  For an automobile, one possible metric might be the time it takes to go from 0 to 60 mph.  This can be measured.  Another metric might be fuel efficiency.  By combining the metrics for a given dimension, a dimension score can be obtained.  Two products can be compared by comparing their dimension scores.

    A number of researchers have shown that service quality is also multidimensional. It is harder to find one set of quality dimensions which apply equally well to many types of services. It is often necessary to develop appropriate service quality dimensions on an industry by industry basis.  Operational zing the dimensions of service quality is frequently more challenging than operational zing the dimensions of product quality.  Operational zing the KQCAH service dimension of respect and caring could result in metrics such as degree of personal interaction with staff, orientation to surroundings, degree of two-way understanding between patient and caregiver, level of patient participation in decision making.  As you can see, these metrics are still more qualitative than quantitative.  Other service quality dimensions are more easily operational zed.  Timeliness could be operational zed as the hours of operation.  Time could be operational zed as the total time for a transaction to be completed.  These metrics can be objectively measured.