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TopQuality In Health Services
The International Organization for Standardization (ISO) defines quality as the degree to which a set of inherent characteristics fulfills requirements (Corbett et al., 2005). According to the Institute of Medicine of the American Academy of Sciences, the quality in health services is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current scientific knowledge (Committee on Quality of Health Care in America, 2001). It focuses on medical procedures (both diagnostic and therapeutic), which can ensure the best possible outcome about the minimum iatrogenic risk, but can also provide the maximum satisfaction for the patient. The quality in the public health sector is essential for the satisfaction of patients, doctors, health-care workers and policy makers. Moreover, quality in a health care system raises prosperity and competitiveness. Health quality is influenced by many factors[REMOVED HYPERLINK FIELD], including health and safety infrastructure, aspects of delivery, technical and professional content of care, and human resources, all of which influence the outcome. Each dimension has complex effects, and many of them are interrelated (Mosadeghrad, 2012, 2014; Shahidzadeh-Mahani et al., 2008). The impact of the economy in health care quality is crucial. Many countries are confronted by fiscal constraints that force them to prioritize and restrict public expenditure (Houston et al., 2011). The effects of the economy also include changes in the demand or the access to health care. Public health systems face further fiscal pressures, due to demographic and epidemiological changes. They have to provide care to increasingly aging populations, degenerative disorders, increased disability and emerging diseases due to stress and lifestyle habits (Mayberry et al., 2000; Mayberry et al., 2008; McKeown, 2009; Nugent, 2008). They also have to invest in expensive medical treatment and technology advances, as well as to the quality improvement. Quality improvement requires the application of Deming´s PDCA cycle, a process based on the continuous feedback so that managers can identify and change the parts of the process that need improvements (Rampersad, 2001). The PDCA cycle includes: