• Ian Howard, Peter Cameron, Maaret Castrén, Lee Wallis, and Veronica Lindström.
• Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
• Emerg Med Australas. 2019 Dec 1; 31 (6): 1024-1036.

ObjectiveDeficits in healthcare quality are becoming an increasing concern globally. Within the low- to middle-income country (LMIC) setting insufficient quality has become a bigger barrier to reducing mortality than insufficient access, where 60% of deaths from conditions amenable to healthcare, are due to poor quality care. Measuring quality is key towards improving the effectiveness of healthcare in this setting.MethodsA mixed methods sequential-explanatory study was conducted, to describe what Emergency Medical Service (EMS) practitioners understood about quality systems within the LMICs, using South Africa as an example. Part 1 consisted of a cross-sectional survey (n = 169), the results of which were utilised to develop a semi-structured interview guide for Part 2. Interviews of participants from Part 1 explored the results of the survey (n = 20) and were analysed through content analysis to develop core categories central to the understanding of quality assessment in the LMICs.ResultsDespite relatively poor knowledge of organisational-specific quality systems, understanding of the core components and importance of quality systems was demonstrated. The role of these systems in the LMICs was supported by participants, where the importance of context, system transparency, reliability and validity were essential towards achieving ongoing success and utilisation. The role of leadership and communication towards the effective facilitation of such a system was equally identified.ConclusionWithin EMS, quality systems are in their infancy. It could be argued that this is somewhat more pronounced in the LMICs, where knowledge of organisational quality systems was found to be poor. Despite this, there was a strong general understanding of the importance of quality systems, and the role they have to play in this setting.© 2019 Australasian College for Emergency Medicine.

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