Small and big quality in health care

Purpose - The purpose of this paper is to clarify healthcare quality's ontological and epistemological foundations; and examine how these lead to different measurements and technologies. Design/methodology/approach - Conceptual analysis. Findings - Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies. Practical implications - The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare. Originality/value - This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts.