Models of quality

Quality is complex and multi-faceted. Various models relevant to Maternal and Newborn Health (MNH) have attempted to capture this from different conceptual perspectives. Figure 2.1 below outlines some of the key models and the emerging thinking in relation to quality:

Figure 2.1: Quality and Key MNH models

Model Framing of quality Key proponent
The systems model (1980) Quality is dependent on various dimensions of the health care system. Donabedian
The perspectives model (1992) Quality is described as dependent on the perspective of the patient, provider or manager. Ovretveit
The dimensions of quality model (1992-2001) Quality is conceptualised by its characteristics (dimensions). These include elements such as effectiveness, acceptability, access, efficiency or equity. Maxwell 1992 ; Institute of Medicine 2001

The systems model has been one of the most influential in looking at quality in health care from a systems perspective. It was originally proposed by Donabedian 1980. Figure 2.2 describes its main features:

Diagram of the systems model

Figure 2.2: The main features of the systems model, originally proposed by Donabedian 1980


The dimensions model has also been influential in encouraging thinking around the different dimensions of quality in the delivery of healthcare. The concept of dimensions is discussed further in the following section.

Question for reflection: what do you see as the practical differences between the 3 different models: i.e. of health systems; perspectives; and dimensions. How do you think the three complement each other in practice?

Asides from the three models in Figure 2.1, quality is framed in other ways, too. For instance, in a later we will explore a rights-based, woman-centered approach to quality (see Windau-Melmer 2013).

For more information on issues related to strategic interventions for quality improvement see Section C.

Models of quality was last modified: June 15th, 2015 by admin