What Quality means

The Institute of Medicine defines healthcare quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making.

The quality of health care is essential for improving health outcomes and meeting national objectives such as the Millennium Development Goals. Yet health care services in many countries are strained by safety and quality problems that result not only from shortages of resources but also from poorly designed systems of care that are not set up to meet patient needs or provide efficient or effective care.

The National Academy of Sciences in the United States has proposed six aims for health care improvement that are appropriate for countries at all stages of development (Crossing the Quality Chasm 2001):

Safety: Health care should avoid injury to patients.

Effectiveness: Services should be based on scientific evidence and be shown to benefit those who receive them.

Patient-centered: Care should be respectful of and responsive to individual patient preferences, needs, and values.

Timeliness: Health care delivery should minimize patient waits and avoid harmful delays.

Efficiency: Care should avoid waste.

Equity: Care provided should not vary in quality because of patient gender, ethnicity, geographic location or socio-economic status.

While many different methodologies and approaches can be applied to improve health care, these six aims provide a useful focus to gauge how well any particular approach achieves real improvement in health care quality and outcomes.