Quality of care as an individual concept: Proposition of a three-level concept for clinical practice


Ebneter AS, Vonlanthen R, Eychmueller S.


Background: Quality in health care is a complex framework with many components. The word "quality" is used in different official settings and different contexts (public health, certification, patient safety). On individual and team levels, the perception of quality is heterogenous, and the term is often used beyond the theoretical framework. Therefore, it remains a challenge to describe the perceived quality of care in the clinical setting. The aim of this paper is to present a simple concept that can be used to visually define the perceived quality of care for the individual health care professional.

Methods/concept: An experience-based concept that uses different levels of "quality of care" individually to guide the supervision of health care professionals (residents) and quality goal setting in teams is presented, with the assumption that the ambition of any health care professional is to provide excellence in care. Three perceived levels of quality of care are defined, described, and visualized, namely, a) security, b) comfort, and c) perfection. The "comfort level" defines a sustainable level of care where the optimal balance between good patient care and resource use is achieved. Excellence of care is located between the comfort and the perfection level. The practical application of this proposed concept is described in three settings, namely, 1) the threshold for asking advice from the supervisor (resident physicians), 2) in supervision/coaching discussions between residents and supervisors, and 3) in the analysis of perceived quality of care and goals setting within the team.

Conclusion: A simplified, purpose-built but well-defined concept to visually depict the perception of quality of care by clinicians can be useful in clinical practice, for the supervision of residents and for team dynamics.