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Table 3 Conceptualizations of quality at the macro level

From: Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems









Health and Social Care Act, Department of Health

National Quality Strategy

National Board of Health’s Quality Regulation and The Health Care Act

The National Quality Act

National Health Plan

Quality definition

Over the last three years, the NHS has coalesced around a shared definition of quality. This was set out by Lord Darzi in the NHS Next Stage Review Leading Local Change as comprising three elements:

The definition of quality is based on meeting the demands of society, meeting legislative requirements, and providing users with the best possible services from a professional perspective. For health and social services, high quality means that the services:

“The health and care services shall be conducted according to requirements for good care. This includes that it shall 1) be of good quality with high hygiene standard and consider patients’ need for safety in care and treatment; 2) be easy to access; 3) be based on respect for patient self-determination and integrity; 4) foster good contact between the patient and health and care professionals; 5) consider the patient need for continuity and safety in the healthcare services.” (translated by authors) [33]:§2a.

"The healthcare provider offers responsible care. Responsible care is defined as care of a good level, at least effective, efficient and patient-oriented care which is geared to the real needs of the patient."

“Quality in health (QeS) can be defined as the provision of affordable and equitable healthcare, with an excellent professional level, taking into account the available resources, while achieving the citizen’s adhesion and satisfaction (Saturno P et al., 1990). It also implies the adequacy of healthcare to the needs and expectations of citizens and the best possible performance.”

•effectiveness of the treatment and care provided to patients

•the safety of treatment and care provided to patients

•the experience patients have of the treatment and care they receive.” [34]:p.9, [20]:p.47.

• Are effective


(translated by authors) [35].

(translated by authors) [36]:p.2

• Are safe and secure

• Involve users and give them influence

• Are coordinated and continuous

• Utilize resources efficiently

• Are available and evenly distributed.”[37]:p.12.

Additional quality dimensions and priorities

Cleanliness, infection reduction, access, responding to emergencies, reduction of health inequalities, staff satisfaction.

Coordinated, integrated, appropriate resource use, available and equally distributed services.

Organizing and management, processes, equity, cooperation, systematic QI.

Timely, transparency on quality outcome, efficient.

Organizational quality, transparency, qualifications, accreditation, mobility, assessment, and complaints.

Inclusion of CE, PS, PE






  1. aThe National Quality Act included CE and PE. Although PS is not explicitly mentioned in the regulation (National Quality Act), there is a strong emphasis on developing indicators on PS. The Minister of health defined quality as fast, good, safe and respectful in a letter to parliament [38]. The Quality act was made in 1996, when PS was not very high on the agenda; meanwhile it has become the main thing also in the Netherlands.