Defining quality in healthcare is not straightforward.  There are a variety of views on its meaning and some debate as to whether quality has to be measurable.  The World Health Organisation (WHO) suggests: "Quality is a process of meeting the needs and expectations of patients and health service staff".

Patient perceptions of quality in healthcare also influence the public expectations and confidence placed in the NHS. Clinical errors, patient suffering and hospital closures always attract media attention while development of new services, changes to treatments and good news stories are hard to publicise.
Crossing the Quality Chasm (Institute of Medicine 2001) proposes an agenda for improving the quality of health care made up of six components:

  • Safe: avoiding injuries to patients from the care that is intended to help them
  • Effective: providing services based on scientific knowledge to all those who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively
  • Patient-centred: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
  • Timely: reducing waits and sometimes harmful delays for bother those who receive and those who give care
  • Efficient: avoiding waste, including waste of equipment, supplies, ideas and energy
  • Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socio-economic status.
These six aims for improvement need to be underpinned by quality improvement systems and processes that support a learning and improvement culture. 


    Krishnakumar Nair

    Lean Healthcare Practitioner
    QI & I Expert
    Lean Champion of the Year 2013, United Kingdom

    View my profile on LinkedIn


    March 2013