Quality in healthcare and the quest for improvement.

Improvement in the quality of healthcare is desired by everyone. Delivering this however, is hindered by lack of clear, widely embraced perceptions of what is encompassed within quality and how improvement can best be brought about. This paper, written from the viewpoint of a clinician now with a responsibility for this field in Scotland, presents a multidimensional concept of quality, as encompassing effectiveness, safety, patient centeredness, timeliness, efficiency and equity. This approach allows views about the relative importance of the various components to differ but also to be reconciled and the different standpoints made coherent. The principal kinds of interventions, aimed to improve one or more aspects of quality, are presented and the need for much greater evidence about their value, alone or in combination is noted. Nevertheless, there is increasing recognition of the importance of emphasising the human factors of attitude, culture and behaviour that provide the best assurance of quality of care to individuals. NHS Quality Improvement Scotland has a key role in searching out knowledge about how improvement is achieved and in engaging with patients and NHS staff to ensure that the necessary advances are achieved in Scotland.