Quality in health care cannot be taken for granted


The study includes the new 5-lens framework, a conceptual model to understand and apply strategies aimed at improving quality of care.

The European Observatory on Health Systems and Policies will formally launch a new study entitled “Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies”, on 22 November 2019 at the 12th European Public Health Conference in Marseille, France. The study aims to help policy-makers better understand the many facets of quality in health care.

Why has quality become such a hot topic in health care?

For a long time, quality was taken for granted – it was considered inherent to health care provided by qualified health professionals. The increasing availability of data now allows researchers and policy-makers to see patterns of variation in health and health-care outcomes within and between countries.

Some of this variation might be expected, for example, in populations with larger numbers of older people or in communities with greater levels of deprivation. Once those factors are controlled for, however, a significant level of variation in health-care outcomes remains. Policy-makers seek to reduce that variation or gap using specifically designed quality improvement measures.

But what does quality mean?

Quality is often quoted as a central principle in health policy, but it can mean different things to different people depending on their perspective as a patient, clinician, manager or policy-maker.

Modern quality improvement initiatives take many forms, such as creating patient safety culture, implementing clinical guidelines, regulating health-care professionals and using health technology assessments to evaluate the benefits of different new technologies. Quality, therefore, has many facets, and as a result it is difficult to define.

How can this study help policy-makers to identify the best approach to quality improvement?

Quality improvement includes a wide range of tools for reducing unwarranted variation in care. Some approaches are simple and inexpensive, for example, handwashing to reduce the risk of infection in health-care settings. Given the many possible approaches to quality improvement, policy-makers need to understand how different quality strategies work, how to evaluate them and how to effectively combine strategies to achieve optimal outcomes.

The Observatory’s new study includes a comprehensive framework to help guide policy-makers through the process of evaluating quality strategies separately and collectively. The 5-lens framework for quality strategies addresses the collection, synthesis and presentation of evidence on common quality strategies, allowing policy-makers to better understand, and then prioritize and apply, strategies in a systematic way.

Quality initiatives need to be aligned and integrated in broader health systems as part of an overall strategy for system improvement. Monitoring concurrent initiatives is key to ensuring that improvement keeps on track.

A group of experts, including the authors of the study, will launch the new publication during the workshop “Quality strategies in European health systems: assessing their nature, use and effectiveness” this Friday at the European Public Health Conference.