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Components of Health Care Quality

SECTIONS: Health Literacy  ~  Medical and Dental Homes Cultural Competency  ~  Family Roles

Doctor with mother, father, and young boyThe Agency for Healthcare Research and Quality (AHRQ) defines quality health care as "doing the right thing, at the right time, in the right way, for the right person - and having the best possible results (see Your Guide to Choosing Quality Health Care on the right).  The Institute of Medicine reframes this definition into measurable components: high-quality care is safe, timely, effective, efficient, equitable, and patient-centered.  Certain aspects of health care can affect quality:


Health Literacy

Health literacy is a newer term that may not be well known to families. The "official definition" from the federal Healthy People 2020 initiative is: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Health literacy is more than just being able to read well (like instructions on medicine bottles). It also includes how you get health information, how well you use information to make health decisions, and what you do to stay healthy or follow through with health recommendations. This is important because so much of staying healthy depends on what you do every day at home. And, if you have a child with special needs there may be other information to understand and tasks to do for your child. Do your best to clarify anything needed while at a health visit, but also don't hesitate to call once you are home. Sometimes that's when questions arise.


Medical and Dental Homes

Every child deserves a primary care medical home and a dental home. This belief is basic to Bright Futures. These "homes" are not buildings or institutions. A medical home is the approach for providing regular and comprehensive primary health care. A dental home is the approach for providing regular dental care. In both the medical and dental home, care is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. A physician-led primary health care team gets to know the child and family. This team identifies and addresses all of their medical and non-medical needs. The family—including the child—and the health care providers are respected as full partners in a child's care.

Initially the concept of a medical home was identified for children with special health care needs because of the complexity of their needs. However, it soon became clear that this is an important model for all children and youth (and for adults as well).

For more information on medical home, please visit the website for the National Center for Medical Home Implementation. In the "For Families" section, you can find many useful tools, such as care notebook templates and tips on how to partner with your health care providers. The National Center for Medical Home Implementation is a cooperative agreement between the Maternal and Child Health Bureau and the American Academy of Pediatrics.

For more information on the dental home, go to the American Academy of Pediatric Dentistry's website


Cultural Competency: Respect and Appreciation for our Differences

Providers should learn the ways to best communicate with families they serve, and learn what partnership means to individual families.

Each family may have a different belief and concept about partnering and communicating with their child's health care provider. All along the way, families should be encouraged to give voice to their thoughts, feelings, expectations, and other issues of importance to them.

Families and providers often find themselves challenged by the multitude of differences they encounter on a daily basis. Some of the differences that providers and families face are based on race and ethnicity, language, nationality, gender, sexual identification and orientation, religion, and income level, to name a few.

Through open communication, the sharing of information and resources, and the ongoing commitment to increasing cultural awareness, knowledge, and skills, bridges can be built that support and enable true partnerships between families and professionals.

For more information, go to the National Center for Cultural Competence at Georgetown University.


Family Roles in Promoting Health and Wellness

Families are key in promoting children’s health—and are also primary providers of care. Of course, care is not only health care in a doctor’s office. It includes the food you serve, encouraging activity, and the other things families do every day. If your child has special needs it may also include carrying out therapies and other forms of care. Families are also role models, teachers, "encouragers," and supporters. Families help children develop patterns of healthy living that can last a lifetime. And families typically oversee the care children receive in other settings and try to make choices about settings and caregivers.

From the very beginning, parents and families are important role models for children—what we do, what we don’t do, the way we handle daily life. (As children grow, other adults often come to play important roles too.) Set a good example for your child. Think about what you say and how you act. Your child learns skills and behaviors by listening to and watching you. Be a positive role model. If you practice healthy habits, it will be easier to convince children to do the same.

There are many, many recommendations for families—from health care providers, teachers, and others—so another family role is to determine how this good advice fits into family life. Being clear about what’s important and what the impact is on your time, energy, and resources sometimes takes time to figure out. If you have questions—or if you disagreed with the recommendations to begin with—do discuss this. Sometimes recommendations can be clarified or modified. In today’s busy world everyone understands that it’s necessary to prioritize.

Family Roles in the Wider Community

Much of Bright Futures addresses care for an individual child—and this is important. However, as you raise your own child you may become aware of needs in your community. Or, you may have ideas that would help your child as well as other children and families. Does your school offer healthy lunches that truly appeal to children? Is it hard to find afterschool activities for children with special needs? Are there enough activities for teens in your community? Maybe you have an idea to make improvements. Or, maybe a group needs help with a project on bicycle safety or cleaning up a park. Pitch in and help. It’s a good way to make your community a nicer place to live and to expand your community partnerships.

You don’t have to be an expert, although if you have special skills and knowledge, it’s great to contribute. Nearly every activity needs people with a range of knowledge and skills. By joining in and helping out, you make things better for everyone.



Parents and families have the main responsibility for raising and caring for their children. Raising children has many joys and rewards, but it is hard, 24/7 work!

You don’t have to do it alone. Create partnerships with all those involved in your child’s life. Most children spend time in a variety of settings. Work with your child’s health care professionals, educators, afterschool staff, coaches, neighbors, etc. You’ll want to ensure that the things most important to you are known and are part of the plans and activities. Partnerships can be formal or informal, short term or lifelong. Partnerships change as your child grows and as your needs, interests, and circumstances do.

In any partnership, families should feel that their experience and traditions are respected. In turn, families should respect the intentions and the expertise of health care professionals and others. As in any relationship there are usually ups and downs and times when compromise and negotiation are needed.

Finally, remember to include your growing child in partnerships that affect his life. Start young, in small ways, and gradually increase his responsibility in his own health care.