Health Care Quality Models in the USA


Health care quality assessment and improvement is a continuous process that has always been pivotal in health care delivery. Every new system of quality measurement is aimed to eliminate the errors which the previous system neglected.

Quality in health care can be defined as a pursuit of excellence in the extent to which health services for patients increase the probability of positive outcomes. The quality of care can be measured with the help of particular indicators, which are based on best practices, i.e. the cases that resulted in considerable improvements. Thus, health quality models are strategies that guarantee accountability of all health care providers, incorporating health care quality indicators with the purpose of ongoing maintenance and development of the service delivery system (Lee, 2012).

Although the 21st century has already made a significant step forward in the pharmaceutical industry, health care service continues lagging. For the past decades, the United States has finally embraced development concepts: the health care system has started to implement quality-enhancing models. Initially, they were heavily affected by the existing industrial models, which predetermined the way quality has been measured up till now (Lin, Kuei, & Chai, 2013).

The most successfully implemented industry-based quality models include:

  • Six Sigma Model;
  • Lean Enterprise Model;
  • the Baldrige National Quality Award Program;
  • ISO 9000;
  • the concept of High-Performance Organizations (Lee, 2012).

Six Stigma Model

“Stigma” is a measurement in statistics that shows the effectiveness of process performance. The higher it is, the fewer defects the product has. Six Sigma is a strategy developed by Motorola, which limits defects to 3.4 or less per million. It was first implemented at General Electric and since then has been continuously increasing the quality level in a whole range of organizations. However, for health care, this approach is rather innovative (Maleyeff & Campus, 2007).

The methodology was very welcome in this field taking into account the notorious amount of medical mistakes. Although it seems rather similar to the previously existing approaches, Six Sigma goes far beyond old models. First and foremost, it excludes any guessing from the assessment process. At each stage, it questions and tests all the assumptions to reduce variability. It is now mostly concentrated on the areas that are more prone to errors (e.g. medication administration). It should be noted that the model has already shown significant results in reducing defects in the spheres of its application. However, it is rather a limited approach, which is unable to solve all the existing problems (Maleyeff & Campus, 2007).

Lean Enterprise Model

The lean Enterprise model has evolved from a tool that was meant to improve organizational performance in the automotive and manufacturing industry and was first introduced at the Toyota Corporation. Its application in health care was limited. The main emphasis of this model is put on standardization. It strives to minimize the waiting time between a customer’s request and service delivery.

The key concept of the model is the concept of value, which is understood as the capability to give the customer exactly what he/she wants in the shortest possible time eliminating all the waste involved (i.e. non-value added activities). Lean principles also presuppose pull instead of push scheduling, empowerment of employees, focusing on effectiveness before efficiency, ensuring stability, and cultivating leadership (DelliFraine, Langabeer, & Nembhard, 2010).

Baldrige National Quality Award Program

The Baldrige National Quality Award Program establishes several quality standards an organization has to meet. It was first implemented in business. There are seven basic standards that it sets. They are:

  • leadership;
  • strategic planning;
  • customer and market focus (patient-oriented);
  • data and analysis;
  • human resource focus;
  • process management;
  • outcomes (Lee, 2012).

The program is perfectly suitable for health care as it aims to achieve international quality standards. A lot of states have adopted quality awards according to the criteria of this program (Lee, 2012).

ISO 9000

The International Organization for Standardization is a network that encompasses 163 countries, which have decided to create an international system of quality requirements in different industries. It has the following benefits:

  • makes the development, production, and supply of goods and services quicker, cleaner, and more secure;
  • encourages interaction among the countries;
  • provides the basis for health care legislation;
  • promotes innovation in pharmacy;
  • provides blueprints for problem-solving (Lee, 2012).

High-Performance Organizations

High-Performance Organization is a status that is attributed to an organization that regularly evaluates and improves its quality standards in pursuit of excellence. Generally, these are organizations that already use all the enumerated models. Their main characteristics are:

  • strong leadership that controls the implementation of the mission;
  • patient-oriented strategic thinking;
  • the anticipation of potential errors;
  • flexibility;
  • resiliency;
  • creativity in approaching problems (Lin, Kuei, & Chai, 2013).


Estimating the given criteria of quality, I can conclude that the agency I am working for (Home Health) can be called a High-Performance Organization for the following reasons:

  • it is patient-oriented and aimed to meet all their needs;
  • it has high safety standards;
  • it encourages collaborative efforts;
  • it pursues excellence in services;
  • it provides learning opportunities.

Besides, the agency successfully implements the modern models, which, I believe, is a good indicator of quality.


DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Healthcare, 19(3), 211-225.

Lee, D. (2012). Implementation of quality programs in health care organizations. Service Business, 6(3), 387-404.

Lin, C., Kuei, C. H., & Chai, K. W. (2013). Identifying critical enablers and pathways to high performance supply chain quality management. International Journal of Operations & Production Management, 33(3), 347-370.

Maleyeff, J., & Campus, H. (2007). Improving service delivery in government with Lean Six Sigma. Washington, DC: IBM Center for the Business of Government.

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