Health Care Quality Determinants
1. Effectiveness – this refers to the degree of achieving desirable outcomes, given the correct provision of evidence-based healthcare services to all who could benefit, but not to those who would not benefit. Effectiveness is the extent to which attainable improvements in health are, in fact, attained. Effectiveness has also been described as the degree to which processes result in desired outcomes, free from error.
2. Safety – this means that degree to which health care processes avoid, prevent, and ameliorate adverse outcomes or injuries that stem from the processes of health care itself. Safety is a dimension that is closely related to effectiveness, although distinct from it in its emphasis on the prevention of unintentional adverse events for patients.
3. Responsiveness – this refers to how a system treats people to meet their legitimate non-health expectations. Another term that is often used synonymously with responsiveness is patient-centeredness. Patient-centeredness is the degree to which a system actually functions by placing the patient/user at the center of its delivery of healthcare and is often assessed in terms of patient’s experience of their health care. The experience of care refers to the caring, communication, and understanding that should characterize the clinician-patient relationship.
4. Accessibility – this refers to the ease with which health services are reached. Access can be physical, financial or psychological, and requires that health services are a priori available.
5. Equity – this is a dimension closely related to access, although it is also used as a metric to assess health-system, financing and outcomes/health status. Equity defines the extent to which a system deals fairly with all concerned. Equity, in this context, deals with the distribution of healthcare and its benefits among people.
6. Efficiency – this is the system’s optima use of available resources to yield maximum benefits or results. It speaks to a system’s ability to function at lower costs without diminishing attainable and desirable results. There are two distinctions – macro-economic efficiency and micro-economic efficiency. Macro-economic efficiency refers to the overall allocation of public and private expenditures in the health system at the right level. Micro-efficiency refers to the value for money realized with available resources.
7. Acceptability – this is the conformity to the realistic whishes, desires and expectations of healthcare users and their families. Since a person’s healthcare experience have a powerful effect on their future utilization of an response to healthcare, responsiveness or patient-centeredness and acceptability are fundamental dimensions to effectiveness and other dimensions.
8. Appropriateness – as a performance dimension, appropriateness is the degree to which provided healthcare is relevant to the clinical needs, given the current best evidence.
9. Competence or capability – this assesses the degree to which health system personnel have the training and abilities to assess, treat and communicate with their clients. There are many potential aspects of competence in this context, including technical competence as well as cultural competence.
10. Continuity – this addresses the extent to which healthcare for specific users, over time, is coordinated across providers and institutions.
11. Timeliness – this is a related concept that is used in several country frameworks and refers to the degree to which patients are able to obtain care promptly. It includes both timely access to care, and coordination of care. There are clinical elements of timeliness, such as the length of time from admission for heart attack to the administration of thrombolytic therapy, an there are patient centeredness aspects of timeliness, such as patients’ perceptions of their ability to get an appointment for needed urgent care as quickly as they wanted.
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