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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.

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