Provide a Framework for Understanding Health Care Quality

Quality information is new and complex, and most people don’t have a clear “mental model” of quality in health care that they can use to understand your report. To overcome these common barriers, you can provide a simple framework that will help people understand what your report addresses while deepening their understanding of quality. (Note about terminology: Health care professionals commonly refer to the “domains” of quality, but that’s not a term with meaning for consumers.)

The IOM Framework

Many health professionals have adopted the Institute of Medicine (IOM) framework for health care quality, which refers to six “aims:” safety, effectiveness, timeliness, patient-centeredness, equity, and efficiency.[1] This model is widely accepted as covering the issues that should be addressed in a comprehensive set of quality measures.

A Simplified Framework

Health care researchers have explored whether consumers are able to “map” various quality measures onto this framework. They are finding that it is a bit difficult unless the number of “aspects” is reduced and the language is simplified.

Consumers seem to understand the following three phrases, which address virtually all of the measures likely to be included in a quality report:[2]

  • Care that protects patients from medical errors and does not cause harm (maps to safety).
  • Care that is proven to work (maps to effectiveness, timeliness, and in some cases to efficiency).
  • Care that is responsive to a patient’s needs and preferences (maps to patient-centeredness and equity).

If your report includes measures in each of these areas, consider using this framework as an organizing principle for the report as a whole, and reporting your indicators within each of the categories. Ultimately, it would be desirable for consumers to expect and look for performance information within these three categories of quality.

Even if your report does not include measures in each category, you can still use this framework. Your reporting program may expand and change over time, so an overarching framework that incorporates issues you may address in the future can be helpful for both your partners and users of the report.

[1] Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. To access this report online or to order a print copy, visit the Web site of the Institute of Medicine at
[2] Hibbard J, Sofaer S. Best practices in public reporting: how to effectively present health care performance data to consumers. Rockville, MD: Agency for Healthcare Research and Quality. 2008.

Also in "Communicating Key Information Upfront"

Page last reviewed November 2018
Page originally created February 2015
Internet Citation: Provide a Framework for Understanding Health Care Quality. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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