6.2. Components of healthcare quality 

According to Donabedian, quality of healthcare has seven pillars/components. These are : 

• Efficacy 
• Effectiveness 
• Efficiency 
• Optimality 
• Acceptability 
• Legitimacy 
• Equity 

1. Efficacy: is the ability of the science and technology of healthcare to achieve desired outcomes under best circumstances. What constitutes "best circumstances" is always difficult to define and controlling other factors is always challenging. Therefore, a more realistic definition could substitute "specified circumstances" for "best circumstances" 

2. Effectiveness: is the degree to which attainable outcomes are attained in reality. It is the comparison between what is achieved in reality with what is potentially achievable with the "best" care provided 

3. Efficiency is the ability to achieve attainable outcomes of care at a lower cost. Improving efficiency means decreasing the cost of care without compromising achievement of maximum attainable results. This can be done by: 

• improving the technology of healthcare (producing more efficient drugs, diagnostic algorisms, etc) 
• improving the process of healthcare to avoid medical errors (harmful, useless or less effective decisions) 
• appropriate use of resources for healthcare 

4. Optimality is the balancing of improvements in health against the cost and other negative consequences of such improvements. It also means optimizing benefits. 

5. Acceptability is the level of conformity to the wishes, desires and expectations of patients. It is usually related to what beneficiaries of healthcare value more including: 

• Accessibility of services 
• Empathetic provider – patient interaction 
• Time, expense, physical comfort to receive services 
• Patient preferences regarding the effects, risks and costs of care 

6. Legitimacy is the conformity of healthcare to social preferences as expressed in ethical principles, values, norms, laws and regulations. It is the equivalent of acceptability as applied to the society. 

7. Equity is conformity to a principle that determines what is just and fair in the distribution of healthcare and its benefits among members of the population.

There are also other of health care quality components – mentioned by other authors and organizations. However, almost all are overlapping with Donabedian‘s seven pillars Some of the other components mentioned by other authors include: . 

• Safety 
• Appropriateness 
• Timeliness 
• Responsiveness 
• Satisfaction 
• Health improvement 
• Continuity of care 
• Technical competence 
• Availability 

Improving all the components of quality requires: 

• Research to improve knowledge 
• Education to transfer knowledge 
• Policy making to create enabling environment for implementation 
• Resource allocation to finance effective interventions 
• Health facilities practices to ensure compliance 
• Patient/client behavior to ensure adherence