To do so, however, will require a better understanding of the practices, processes, and initiatives needed to improve patient outcomes within healthcare teams. Similar issues and initiatives also exist in other countries ( World Health Organization, 2003).ДЄn additional challenge noted in these reports is the need to improve data and measures to provide a more complete assessment of priorities (AHRQ, 2014). The most recent National Healthcare Quality Report, published in 2015, reveals a number of measures that showed no change or worsening of quality ( AHRQ, 2015a). Quality indicators include structure, process, and outcome measures that are reported annually in the National Healthcare Quality Reports, thus providing an overview of the quality of health care in the United States. Despite these efforts, many quality indicators of healthcare quality have actually worsened, and public trust of hospitals and healthcare professionals continues to erode ( Agency for Healthcare Research and Quality, 2009). Evidence suggests that the safety and quality of care in hospitals can be recognizably improved ( Pronovost, Thompson, Holzmueller, Lubomski, & Morlock, 2005). Ongoing quality efforts to identify and implement better, more effective patient care practices now exist in virtually every healthcare institution. The widely acknowledged prevalence of avoidable patient harm and adverse outcomes has led to routine use of the term healthcare quality, with professionals, patients, consumers, and regulatory agencies among the many parties regularly referring to it ( Hughes, 2008).

Medical errors are now the third leading cause of death in the United States ( Makary & Daniel, 2016). Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Similar attributes were grouped into themes during analysis. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings.

Peer-reviewed articles and government publications published in English from 2004 to 2016 were included.

Search terms included health care and quality, as well as healthcare and quality. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Walker and AvantвЂ™s method of concept analysis, the most commonly used in nursing literature, provided the framework. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Worsening quality indicators of health care shake public trust.

Drive 2011 analysis