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Table 2 Proposed conceptual framework dimensions based on key elements of healthcare quality frameworks and value statements

From: Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda

  Patients Employed and affiliated staff Costs Service provision
Clinical outcome Experience Access Processes Continuous improvement Strategic perspective
Quality frameworks
IHI Triple aim [32] • Population health • Experience of care   • Per capita cost     
Quadruple aim [33] • Population health • Experience of care • Wellbeing • Per capita cost     
IOM domains of healthcare quality [34] • Safe
• Effective
• Patient-centered   • Efficient • Timely
• Equitable
Balanced scorecard:
Perspectives [64]
• Customer value • Customer satisfaction and/or retention • Learning & growth
o human capital
o culture
• Financial
o financial performance
o effective resource use
  • Internal process
o efficiency
o quality
  • Learning & growth
o infrastructure & technology
o culture
The Malcolm Baldrige Criteria for Performance Excellence [65] • Results:
o Product/Service
• Results:
o Customer Satisfaction
• Workforce focus
• Results: workforce
• Results: Financial and marketplace performance   • Results: operational effectiveness • Measurement, analysis, and knowledge management • Leadership
• Strategic planning
• Results: Leadership
• Customer Focus
OECD Health Care Quality Indicators Framework [66] • Quality:
o Effectiveness
o Safety
• Quality:
o Responsiveness
o Patient Centeredness
  • Cost/Expenditure • Access
o Accessibility
Total Quality Management Principles [67]   • Customer Satisfaction • Employee commitment     • Continuous Improvement • Fact-Based Decision Making
• Effective Communications
• Strategic Thinking
• Integrated System
WHO Regional Office for Europe: Performance Assessment Tool for Quality Improvement in Hospitals (PATH) [68] • Clinical effectiveness
• Safety
• Patient Centeredness • Staff orientation    • Production efficiency   • Responsive Governance
Campbell et al.
Quality of Care Conceptual Framework [69]
• Effectiveness:
o Effectiveness of Clinical care
• Effectiveness:
o Effectiveness of inter-personal care
   • Accessibility:
o Affordability
o Availability
A framework for High-Reliability Organizations in Healthcare [70]   • Engagement of patients and family • Culture of safety
o Psychological safety
o Accountability
o Teamwork & communication
o Negotiation
    • Learning system
o Continuous learning
o Improvement & measurement
o Reliability
o Transparency
• Effective leadership
Value statements
WHO: Goals of the Health System[71] • Optimal health for all • Responsiveness of care provision system   • Fair financing     
Shingo guiding principles[36] • Assure quality at the source • Respect every individual • Respect every individual
• Create constancy of purpose
   • Focus on process
• Flow & pull value
• Seek Perfection
• Embrace Scientific thinking
• Lead with humility
• Think systemically
• Create value for the customer
Lean 4P Model[35] • Philosophy (Create value, customer focus) • People    • Process • Problem solving  
EFQM Excellence Model: Fundamental Concepts of Excellence[72] • Adding Value for Customers     • Managing with agility • Creating a sustainable future
• Developing organizational capability
• Harnessing creativity and innovation
• Leading with Vision, Inspiration and Integrity
  1. Abbreviations: EFQM the European Foundation for Quality Management; IHI Institute for Healthcare Improvement; IOM Institute of Medicine; OECD Organisation for Economic Co-operation and Development; WHO World Health Organization