What is quality and how can it be improved?


What is quality?

Within health care, there is no universally accepted definition of ‘quality’. However, the majority of health care systems around the world have made a commitment to the people using and funding their services to monitor and continuously improve the quality of care they provide.

In England, the NHS is ‘organising itself around a single definition of quality’: care that is effective, safe and provides as positive an experience as possible by being caring, responsive and  personalised. This definition also states that care should also be well-led, sustainable and equitable, achieved through providers and commissioners working together and in partnership with, and for, local people and communities (see Box 1).

Box 1: The dimensions of quality

People working in systems deliver care that is:

Safe Avoiding harm to people from care that is intended to help them.

Effective Providing services that are informed by consistent and up-to-date high-quality training, guidelines and evidence.

Caring Delivering care with compassion, dignity and mutual respect.

Responsive and personalised Ensuring services are shaped by what matters to people, and empowering people to make informed decisions and design their own care.

Health care organisations and systems are: 

Well-led Driven by collective and compassionate leadership, underpinned by a shared vision, values and learning, a just and inclusive culture and proportionate governance.

Sustainably-resourced Focused on delivering optimum outcomes within available finances, and reducing the negative impact on public health and the environment.

Equitable Committed to understanding and reducing variation and inequalities and ensuring that everybody has access to high-quality care and outcomes. 

It is important that health care organisations consider all these dimensions when setting their priorities for improvement. Often the dimensions are complementary and work together. However, there can sometimes be tensions between them that will need to be balanced. It is therefore necessary to consider all stakeholders’ views and to work together to identify improvement priorities for an organisation or local health care system.

How can we improve quality?

A long-term, integrated whole-system approach is needed to ensure sustained improvements in health care quality. Several factors (also discussed in Sections 3 and 5) are required to drive and embed improvements in a health care organisation or system.,,,,,

Leadership and governance

  • Establishing effective leadership for improvement.
  • Creating governance arrangements and processes to identify quality issues that require investigation and improvement.
  • Adopting a consistent, aligned and systematic approach to improving quality.
  • Developing systems to identify and implement new evidence-based interventions, innovations and technologies, with the ability to adapt these to local context.

Improvement culture, behaviours and skills

  • Building improvement skills and knowledge at every level, from the top tiers of organisations, such as the boards of acute trusts or primary care networks, through to front-line staff.
  • Recognising the importance of creating a workplace culture that is conducive to improvement.
  • Giving everyone a voice and bringing staff, patients and service users together to improve and redesign the way that care is provided.
  • Flattening hierarchies and ensuring that all staff have the time, space, permission, encouragement and skills to collaborate on planning and delivering improvement.

External environment

  • Policy and regulatory bodies supporting efforts to develop whole-system approaches to improvement.
  • Government ensuring that health and care services are appropriately resourced to deliver an agreed standard of quality.

What does quality improvement involve?

Quality improvement draws on a wide variety of approaches and methods, although many share underlying principles, including:

  • identifying the quality issue
  • understanding the problem from a range of perspectives, with a particular emphasis on using and interpreting data
  • developing a theory of change
  • identifying and testing potential solutions; using data to measure the impact of each test and gradually refining the solution to the problem
  • implementing the solution and ensuring that the intervention is sustained as part of standard practice.

The successful implementation of the intervention will depend on the context of the system or the organisation making the change and requires careful consideration. It is important to create the right conditions for improvement and these include the backing of senior leaders, supportive and engaged colleagues and patients, and access to appropriate resources and skills.

Previous Next