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:
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.
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.
- Ovretveit, J., (1992) Health Service Quality. An Introduction to Quality Methods for Health Services
- Donabedian, A., (1980) Explorations in Quality Assessment and Monitoring Vol. 1. The Definition of Quality and Approaches to Its Assessment
- Windau-Melmer, T., (2013) A Guide for Advocating for Respectful Maternity Care
- Maxwell RJ, (1992) Dimensions of quality revisited: from thought to action
- Institute of Medicine , (2001) Crossing the quality Chasm. A new health system for the 21st century.
- Maxwell, R.J., (1992) Dimensions of quality revisited: from thought to action