Quality in general practice - definitions and frameworks.

BACKGROUND In 2010, the federal government introduced the first comprehensive national policy statement for primary healthcare in Australia. This policy identifies key reform initiatives with the overall aim of improving the quality of healthcare. However, what constitutes quality and how to measure it is the subject of ongoing debate both nationally and internationally. OBJECTIVE In this article we explore the current experience of defining quality and implementing quality frameworks in general practice settings in New Zealand, the United Kingdom, Germany and Australia. DISCUSSION There are multiple and varying definitions of quality in general practice, but most emphasise patient experience as their primary focus. The quality frameworks used in the countries investigated are all based on Donabedian's systems-based framework of structure, process and outcome. Implementation and application varies however, with top-down approaches in New Zealand and the United Kingdom, and bottom-up approaches in Germany. Provision of high quality care is the primary goal in all the systems described. External standards, targets and incentives are important initiatives, but countries with high quality general practice excel at empowering general practice to own the quality agenda.