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Researchers have conceptualized quality of life on many levels, and there are multiple views on how it should be defined and measured [ 1].
Table 5 illustrates how professionals at the micro level conceptualized quality.> To summarize, the micro level results showed a striking diversity of conceptualizations of quality.
The World Health Organization conceptualized quality of life as the 'individual's perception of their position in life in the context of culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns' [ 2].
At both Swedish hospitals the senior hospital managers conceptualized quality as a key task for doctors and nurses, and had implemented a model where all employees have specified time in their schedule for QI work, and mandatory inter-professional QI training, in addition to their ordinary clinical work.
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This framework conceptualizes quality from both the user's experience and providers' provision with care.
Studies of the macro level pinpoint how national and international institutions, such as OECD, Department of Health (UK) conceptualize quality through measurements and classification frameworks [ 13].
Admittedly, we do not conceptualize quality end-of-life care as a public health problem in the same way we conceptualize HIV, malaria and TB as public health problems.
A widely accepted definition of quality proposed by the Institute of Medicine conceptualizes quality as the degree to which health services for individuals and populations are consistent with current professional knowledge and increase the likelihood of desired health outcomes [ 20].
By conceptualizing quality end-of-life care as a global public health and health systems problem, it also falls under the scope of WHO's initiatives on health system performance, a point to which we will return below.
The strong professional culture and organizational identity at Site B conceptualizes quality largely in terms of clinical effectiveness, which could be counterproductive in terms of recognizing the importance of the patient perspective and promoting shared decision making in clinical encounters (such as decision making about C-sections) and QI work.
However, conceptualizing quality end-of-life care as a global public health and health systems problem, as we have done in this paper, does lead to certain clear conclusions about the sorts of initiatives that will help to improve this problem.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com