“While policies, governance structures, data and digital tools co-enable reforms, it is healthcare professionals who bring quality strategies to life in practice – guided by the insights, needs, and expectations of the people and communities they serve.” (Fonseca et al 2025)

At the end of last year, I was drawn to a paper in the European Journal of Public Health by Válter Fonseca and colleagues from WHO: Quality of care in an era of global challenges: A transformational vision for the WHO European Region and beyond. The paper proposes a bold reframing of quality of care, one that moves decisively beyond traditional, compliance-driven models.

What particularly caught my attention was its strong focus on leadership and its clear relevance to patient safety. The authors argue that leadership at all levels is essential to catalyse the transformation required: shifting from fragmented expert silos to integrated care pathways, and from guideline adherence alone to patient-centred, continuously improving systems.

The paper reflects on how the concept of quality has expanded over recent decades to encompass safety, effectiveness, efficiency, equity, and people-centredness. Yet it also makes a persuasive case that many quality approaches still fall short, too often prioritising service volume and process compliance over outcomes, coherence, and purpose across complex health systems.

Grounded in a review of major global reports - including WHO Regional Office for Europe’s Taking the Pulse of Quality of Care (2024), which highlights persistent disparities across European countries, the paper underscores why incremental change is no longer enough.

To address this, the authors propose three key enablers for sustainable quality reform:
1.    people, leadership, and a drive for change;
2.    data and transparency; and
3.    innovative solutions and tools.

Together, these enablers point to a simple but powerful message: quality health systems are built on empowered professionals, trustworthy data, and responsible innovation. Leadership, learning, and culture enable safer, more integrated care; data and transparency support accountability and trust; and digital solutions can accelerate progress when ethically guided and designed around people.

Importantly, the paper does not stop at vision. It offers concrete country examples from across the WHO European Region, showing how these ideas are being put into practice, with active support from the WHO Regional Office for Europe and its Athens Quality of Care and Patient Safety Office.

I found the paper stimulating and focused on real world practice. Its emphasis on competencies, leadership support, motivation, and co-design resonates strongly with patient safety work. I was particularly struck by the authors’ reminder that “quality of care cannot be separated from the quality of health systems as a whole” and by their reframing of quality not as a technical add-on, but as a core principle underpinning health system effectiveness, resilience, and equity.

For anyone interested in leadership, patient safety, and meaningful quality improvement, this paper is well worth the read.
 

Thanks @JULES STORR And I strongly agree with their vision: 

'In response, this paper proposes a transformational vision for quality of care that moves beyond traditional models. This vision is rooted in two interconnected pillars. First, a focus on outcomes that truly matter to people and populations, prioritizing health and well-being over service volume. The second pillar is a whole-systems perspective that embeds quality across all levels of governance, policy, and financing.'

The narrative of reducing waiting lists and addressing financial defeicits, the predominant focus of current leadership, is an eaxmple of why there needs to be a great focus on outcomes, including safer care.