Dimensions of Quality
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 (Quality Assurance Project, 1993).
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 (Avedis Donabedian, 1982).
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 (M.I. Roemer and C. Montoya Aguilar, WHO, 1983).
The most comprehensive and perhaps the simplest definition of quality is that used by advocates of total quality management (W. Edwards Deming, 1982): "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 (i.e., adhere to standards)
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 are important to clients
Choice: As appropriate and feasible, client choice of provider, insurance plan, or treatment