ArticleBulletin of the World Health Organization2017
Understanding and measuring quality of care: dealing with complexity.
Article in Bulletin of the World Health Organization, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 170 papers, 15 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
170 citing papers in PubMed, 15 syntheses or guidelines pooled it.
- Factors Influencing Community Members' Perception of Primary Health Care Services Delivered by Community Health Workers in Rural Areas: A Systematic Review.The Australian journal of rural health · 2026Pooled it
- What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence.Health policy and planning · 2025Pooled it
- Introduction and Systematic Review of the Good Nursing Care Scale.Journal of clinical nursing · 2025Pooled it
- Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting.The European journal of general practice · 2024Pooled it
- Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.PloS one · 2024Pooled it
- Quality of adolescent and youth-friendly sexual and reproductive health services and associated factors in Ethiopia: a systematic review and meta-analysis.Frontiers in public health · 2023Pooled it
- A systematic literature review of patient self-assessment instruments concerning quality of primary care in multiprofessional clinics.Family practice · 2022Pooled it
- Evaluations of effective coverage of maternal and child health services: A systematic review.Health policy and planning · 2022Pooled it
- A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries.Journal of global health · 2022Pooled it
- Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis.International journal of environmental research and public health · 2021Pooled it
- Pooled it
- Variability in Health Care Quality Measurement among Studies Using Service Provision Assessment Data from Low- and Middle-Income Countries: A Systematic Review.The American journal of tropical medicine and hygiene · 2020Pooled it
- Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases.BMJ global health · 2020Pooled it
- How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities.Health policy and planning · 2019Pooled it
- Pooled it
- Trial
- Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.PloS one · 2021Trial
- Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2020Trial
- Process-related determinants of quality of care for individuals with sickle cell disease in a tertiary facility in Ghana.BMJ open · 2026Article
- Assessing the quality of care in low- and middle-income countries: a rapid review of the landscape of assessment tools.BMJ global health · 2026Review
110 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality as a driver of service utilization; quality as a concept shaped over time through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct co-produced by families, individuals, networks and providers; and the implications of our observations for measurement. Within the communities and societies where care is provided, quality of care cannot be understood outside social norms, relationships, trust and values. We need to improve not only technical quality but also acceptability, responsiveness and levels of patient-provider trust. Measurement approaches need to be reconsidered. An improved understanding of all the attributes of quality in health systems and their interrelationships could support the expansion of access to essential health interventions.
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Registered trials
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