What is Quality?
Our BC Health Quality Matrix provides a shared definition of quality for British Columbia’s health care system.
That means all health and wellness services, anywhere in the province, have a consistent foundation from which to support people and their communities to thrive.
We first published the Matrix in 2009, after which the definition of quality was adopted by the province’s health authorities, Ministry of Health and many health organizations when setting priorities and caring for people. We published an updated version in February 2020 which ensures British Columbia’s vision of high-quality care aligns with the latest evidence and honours the history and teachings of Indigenous Peoples in the province.
Vancouver Coastal Health’s Virtual Health Team adapted the Matrix into a yes/no checklist that’s used to highlight the dimensions of quality that are impacted by the introduction of virtual health.
Dimensions of Quality
Quality is defined by seven dimensions that span the full continuum of care:
- Respect: honouring a person’s choices, needs and values
- Safety: avoiding harm and fostering security
- Accessibility: ease with which health and wellness services are reached
- Appropriateness: care is specific to a person’s or community’s context
- Effectiveness: care is known to achieve intended outcomes
- Equity: fair distribution of services and benefits according to population need
- Efficiency: optimal and sustainable use of resources to yield maximum value
Areas of Care
The continuum of care distinguishes between five interconnected Areas of Care. Each area represents different experiences within a person’s or community’s continual journey toward physical, mental, emotional and spiritual health and wellness.
- Optimizing the Early Years: advancing early development and maternal health and wellness
- Strengthening Health and Wellness: promoting well-being and preventing injury, illness and disability
- Returning to Health and Wellness: getting better when faced with acute illness or injury
- Living with Illness or Disability: care and support for living with chronic illness and/or disability
- Coping with Transition from Life: planning, care and support for life-limiting illness and bereavement
The Matrix is useful for anyone engaged in the health system – including administrators, practitioners and patient partners – for planning, assessing, improving and teaching at the practice, program, site and system levels.
The BC Health Quality Matrix
The Matrix can be used to develop metrics that comprehensively measure quality across seven Dimensions of Quality and five interconnected Areas of Care. By providing a shared definition of quality for BC, the Matrix supports a coordinated approach to thinking and learning about these dimensions and areas, how they relate to one another, and what everyone’s responsibilities are throughout a person’s health and wellness journey. Greyscale version available here.Download the Matrix
The Companion Guide
The Companion Guide provides more information on applying the definition of quality in your setting. It includes expanded examples and case studies to illustrate various ways of using the Matrix for different purposes across the continuum of care. This includes strategic planning, measuring and evaluating a program’s impact, leading improvement projects and developing metrics. Greyscale version available here.Download the Companion Guide
Matrix Visual Tool
While all the parts of the Matrix are interconnected, considering the different Dimensions of Quality and Areas of Care is a useful way to think about and measure quality. This visual was created as a tool to guide the use of the Matrix in practical ways. Greyscale version available here.Download the Visual
In February 2020, the Matrix was re-published with updates which emphasize the link between social determinants of health and quality, stress the importance of the early years of life as integral to health and align with the health care system’s focus on promoting wellness.
The updates also embed Indigenous perspectives on health and wellness and identify what is possible when Indigenous and non-Indigenous worldviews are welcomed. This inclusion is in alignment with BC’s commitment to fully adopt and implement the United Nations Declaration on the Rights of Indigenous Peoples, and the Calls to Action of the Truth and Reconciliation Commission.
Throughout the BC Health Quality Matrix, the concept of health quality has been broadened to include health and wellness, and focus has been placed on the whole person. Additionally, the concept of care as relational has been strengthened, and core values of cultural safety and humility as well as person- and family-centred care have been enhanced.
If you’re familiar with the previous version of the Matrix, some of the specific updates include:
- The Respect dimension (previously named Acceptability) now more clearly honours a person’s choices, needs and values.
- The Safety dimension now includes fostering security and trust, in addition to avoiding harm.
- The Equity dimension now recognizes that providing equitable care requires understanding and recognizing differences in people’s histories and experiences.
- A new Area of Care – Optimizing the Early Years – accounts for the critical role of the early years of life.
The Matrix provides a common language and understanding about quality for all those who engage with, deliver, support, manage and govern health and wellness services. Having a shared definition for BC facilitates a coordinated approach to thinking about the multiple Dimensions of Quality, how the dimensions relate to one another, and responsibilities throughout a person’s health and wellness journey.
It also enables the development of metrics that comprehensively measure quality across the continuum of care and across dimensions. While all the parts of the Matrix are interconnected, considering the different dimensions and areas is a useful way to think about and measure quality. Learn more about how to apply the Matrix in our companion guide.
When the Matrix was updated in 2020, we ensured it aligns with the health care system’s focus on promoting wellness. This means addressing people’s needs while also supporting them to stay well, build on their strengths and thrive.
Supporting health and wellness requires us to consider the whole person. This includes their physical, mental, emotional and spiritual well-being. It also includes the broader determinants that impact their well-being, such as past and present familial, social, cultural and environmental context.
And when we talk about supporting people’s health and wellness we mean the many connections, treatments and services that encompass providing care. Relationships are at the core of all these interactions, including those with patients and communities, among providers and within care teams. A key way to address this relational nature of care is to practice cultural humility*.
*Cultural humility is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.1
Equity in health care refers to the just distribution of services and benefits according to population need. Ensuring the equitable delivery of health and wellness services is a critical part of advancing high-quality care across a health system.
- First Nations Health Authority. Cultural Humility [Internet]. 2020 [cited 2020 Jan 1]. Available from: https://www.fnha.ca/wellness/cultural-humility