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9 Dimensions of quality in healthcare

9 Dimensions of quality in healthcare

In health care, dimensions of quality refer to aspects of care or service provided to clients which individually or together contribute to the framework within which the quality of services provided can be judged. Various dimensions of quality have been developed from the technical literature and synthesize ideas from various quality improvement experts.  Together, they provide a useful framework that helps health teams to define, analyse, and measure the extent to which they are meeting facility standards for clinical care and for management services that support service delivery.

Dimensions of quality

The following nine dimensions of quality, when considered during health care service delivery are known to contribute to better client outcomes as well as patient satisfaction.

  1. Technical performance
  2. Effectiveness of care
  3. Efficiency of service delivery
  4. Safety
  5. Access to service
  6. Interpersonal relations
  7. Continuity of services
  8. Physical infrastructure and comfort
  9. Choice of services.

Technical Dimensions of quality in healthcare performance

The degree to which the tasks carried out by health workers and facilities meet the expectations of technical quality (comply with standards). Technical performance refers to the skills, capability, and actual performance of health providers, managers, and support staff.

Effectiveness of Care

This dimension refers to the degree to which desired results (outcomes) of care are achieved through appropriate diagnosis and treatment. It requires the provision of appropriate services based on scientific knowledge to all who could benefit, refraining from providing services to those who would likely not benefit and avoiding underuse and overuse of treatment or services. Success of service delivery is measured based on the expected outcome of doing the right thing for the right person at the right time.


Efficiency of service delivery

Efficiency refers to the use of minimum resources to achieve desired results. This is an important dimension of quality because it affects product and service affordability and because health care resources are usually limited. When we provide optimal rather than maximum care to the patient and community, we provide the greatest benefit within the resources available.

Poor care resulting from infective norms or incorrect delivery should be minimized or eliminated. In this way, quality can be improved while reducing costs. Harmful care, besides causing unnecessary risk and patient discomfort, is often expensive and time consuming to correct. It would be misleading, however, to imply that quality improvements never require additional resources. But by analyzing efficiency, health facility supervisors may select the most cost-effective interventions.


Safety refers to the degree to which the risks of accidental or preventable injury, infection or other harmful side effects produced by medical care are minimized. Safety requires a system of care delivery that prevents errors, learns from the errors that do occur and is built on culture of safety that involves health care providers and patients.

Access to services

Access to service refers to the degree to which healthcare services are accessible by all; not restricted by geographic, economic, social, organization or linguistic barriers.

Geographic access by may be measured by modes of transportation, distance, travel times, and any other physical barriers that could keep a client from receiving care.

Economic access refers to the affordability of products and services for clients and for travel, if applicable.

Social or cultural access relates to service acceptability within the context of the client’s cultural values, beliefs and attitudes. For example, family planning services may not be accepted if they are offered in a way that is inconsistent with the local culture.

Organizational access refers to the extent to which services are conveniently organized for prospective clients, and encompasses issues such as clinic hours and appointment systems, waiting time, and the mode of service delivery. For example, the lack of evening clinics may reduce organizational access for day labourers.

Linguistic access means that the services are available in the local language or a dialect in which the client is fluent.

Interpersonal relations

Positive interpersonal interaction between client and provider can play a large role towards proper service provision and high client satisfaction. Positive interpersonal relations can be defined by a close, friendly or pleasant association between two or more people, often based on regular business interactions or social commitment that may be brief or long term. Interpersonal relations are enhanced when confidentiality, trust, respect, responsiveness, empathy and effective communication is practiced between providers and clients. Providers are primarily responsible for initiating this type of interaction.

Continuity of services

Continuity of services ensures uninterrupted and consistent services are provided to the population/community.

Continuity means that the client receives the complete range of health services that he or she needs, without interruption or unnecessary repetition of diagnosis or treatment. Services must be offered on an ongoing basis. The client must have access to routine and preventive care provided by a health worker who knows his or her medical history. A client must also have access to timely referral for specialized services and too complete follow-up care.

Continuity can be achieved by ensuring that the clients always see the same primary care provider; it can also be achieved by keeping accurate medical records so that a new provider knows the patient’s history and can be build upon and complement the diagnosis and treatment of previous providers.

The absence of continuity can compromise effectiveness, decrease efficiency and reduce the quality of interpersonal relations.

Physical infrastructure and comfort

The physical infrastructure and comfort of the facility in relation to physical appearance, provision of privacy, and other aspects are important to clients.

Physical infrastructure and comfort refer to the features of health services that do not directly relate to clinical effectiveness but may enhance the client’s satisfaction and willingness to return to the facility for subsequent health care needs. Physical infrastructure is also important because it may affect the client’s expectations about and/or confidence in other aspects of the service or product.


Physical infrastructure and comfort may include features that make the wait more pleasant such as music, educational or recreational videos and reading materials. Clean, accessible restrooms and privacy curtains in examination rooms may be considered luxuries in some health care settings; they are nevertheless important for attracting and retaining clients and for ensuring continuity of coverage.

Choice of services

The client can decide which facility to attend, time to seek health care and treatment plan.


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