How We Define Quality in Health Care: Finding Common Ground for Better Outcomes

Quality in antenatal care provision can mean different things to different types of stakeholders. Considering this diversity of perceptions is critical to achieving better health outcomes. Photo: JSI Ethiopia

By Bezawit Tsegaye, health services management and administration advisor, USAID Quality Healthcare Activity

People involved in health care may hold different perspectives on what characterizes high-quality care. The evolution of key definitions in health care quality has prompted various reforms and improvements within national health systems, but the differences among views have often been overlooked. The term “quality of care” might signify different concepts to patients, clinicians, and managers. How might these differing perspectives of quality influence delivery, health outcomes, and, ultimately, the success of the health system?

Consider a woman expecting her first child, visiting a health center for antenatal care. Regardless of the context, she will want clear communication about the condition of her pregnancy, comprehensive prenatal education, and an attentive provider who addresses her specific concerns. High-quality care, from her perspective, would involve feeling informed, respected, and supported.

For the provider however, quality of care might translate to the provision of evidence-based and coordinated care, all while building a “trusting” relationship with the client. Seeing the situation from yet another point of view, the health center’s medical director might define quality through clinical outcomes, optimization of resources, and implementation of evidence-informed best practices to maintain high standards of care. Though they vary, all of these perspectives are valid and should be well integrated by health systems into any quality management approach.

The USAID Quality Healthcare Activity (QHA) in Ethiopia recognizes that embracing the diversity of perceptions in quality improvement efforts is critical to achieving optimal service delivery and health outcomes. By generating much-needed evidence and supporting research initiatives that delve into the nuances of these perceptions of quality, programs can pave a path for harmonization and an inclusive approach to enhance service delivery. A five-year, USAID-funded project, QHA is dedicated to understanding and harmonizing how health systems actors think about and enact quality in health care to improve reproductive, maternal, newborn, child, and adolescent health service delivery.

Bringing definitions of quality to the forefront of discussions around health systems strengthening is only half of the work; the other half involves changing systems to deliver care in a way that brings us closer to a harmonious definition of quality. To do this, JSI’s locally led team is building a transformative systems approach to quality that includes continuous and adaptive learning and that considers and integrates the perspectives of various health system actors.

This strategy provides custom-fit structural and performance quality improvement interventions for more than 690 health facilities in 81 woredas. The interventions, which include trainings, supportive supervision, and implementation of health practice innovations, are informed by continuous learning sessions. Held across stakeholder groups, these sessions explore diverse viewpoints. Operations research also helps inform the interventions, enabling us to better understand knowledge, attitudes, and behaviors across reproductive, maternal, newborn, and child health service platforms. We couple these interventions with advocacy for practices and policies that enable optimized health outcomes at various levels of the health system.

This is no one-size-fits-all approach to health systems strengthening, but an individualized approach wherein we listen to communities and meet them where they are. All health system actors are included in the process, and all share an equal voice in how we improve quality of care in each setting. This approach marks an important leap forward in health care quality improvement; our hope is that it ushers in a new standard for patient care. Over these next few years, QHA will build toward this community-empowered approach to improve the health outcomes of children, their mothers, and families.

Learn more about QHA’s journey to strengthen Ethiopia’s primary health care systems.