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International Journal for Quality in Health Care 14:67-073 (2002)
© 2002 International Society for Quality in Health Care

Methodological Approaches

A framework for institutionalizing quality assurance

DIANA R. SILIMPERI, LYNNE MILLER FRANCO, TISNA VELDHUYZEN VAN ZANTEN and CATHERINE MACAULAY1,2

Quality Assurance Project, University Research Co., LLC, Bethesda, MD
1Martha Elliot Health Center, Boston, MA, USA
2Formerly at the Quality Assurance Project

Objective. To develop a framework to support the institutionalization of quality assurance (QA).

Design. The framework for institutionalizing QA consists of a model of eight essential elements and a ‘roadmap’ for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining quality assurance activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of pre-awareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously.

Conclusion. The framework has been introduced in nearly a dozen countries in Latin America and Africa. The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA.

Keywords: framework for quality assurance, institutionalization framework, leadership for quality, organizing for quality, quality assurance, sustainability of quality assurance


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