Small and big quality in health care.

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.