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