A quality framework for health services developed through an inclusive approach

Objective: This study set out to explore and define the concept of “quality” from the perspective of health service managers and health professionals in Ireland, and to develop a theory to inform the development of a quality framework for the Irish health system. Methods: Design: The study design was based on Strauss and Corbin’s (1990) grounded theory approach. This provided a method of social inquiry with the purpose of developing a theory through a systematic and rigorous approach to examine and advance emerging concepts. Setting and participants: Fifty health service managers and professionals employed by the Health Service Executive (HSE) in Ireland participated in this study. Interventions: In-depth interviews were used to explore with participants their experiences of quality in Irish health services, definitions of quality and the elements necessary for a quality framework. Main outcomes: This study produced a substantive theory that identified the need for a holistic approach to quality across three domains (the patient, workforce and organisation). Results: The quality framework comprises an integrated set of domains, values, approaches, processes and enablers. Across the domains, the approaches and processes provide the mechanisms to achieve quality. These are supported by values (that promote quality) and a set of enablers (which underpin the elements, providing the platform for change). Conclusions: The emergent theory provides the basis for a quality framework for health services for Ireland in the 21st Century. Unlike most extant quality frameworks, the framework was derived empirically through an inclusive approach with key care providers, supporting the relevance and potential utility of the framework.