title: Small and big quality in health care.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Conceptual analysis.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland.
authors.forename: Paul Martin
authors.initials: PM
authors.lastname: Lillrank
mesh_terms: D003657:Decision Making; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D019359:Knowledge; D061214:Patient Safety; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care
keywords: Clinical decision making; Integrated quality; Patient experience; Patient safety; Quality definition; Quality healthcare; Quality system