Principles and challenges of quality management in primary care


  • Faisal Ahmad Aljuhani Chronic Disease Department, Public Health Administration-Ministry of Health, Jeddah, Saudi Arabia
  • Abdullah Mohammed Alhejji Department of Family Medicine, Al-Ahsa Health Clusters, Al-Ahsa, Saudi Arabia
  • Musaad Sulaiman Aljaloud Qassim Health Clusters, Qassim, Saudi Arabia
  • Turki Habib Al Shammari Department of Family Medicine, King Abdulaziz Air Base Hospital, Dhahran, Saudi Arabia
  • Abdulelah Abdullah Aljurbua Department of Family Medicine, Al Bukayriyah General Hospital, Al Bukayriyah, Saudi Arabia
  • Nesma Saleh Turkostany Department of Emergency Medicine, National Guard Health Affairs (NGHA), Mecca, Saudi Arabia
  • Abdullah Hasem Alhassan College of Medicine, Medical University of Lodz, Lodz, Poland
  • Nada Naji Aljuaid College of Medicine, Taif University, Taif, Saudi Arabia
  • Mashael Mohammed Jereb Primary Health Care, Health Affairs in Jazan Region-Middle Sector, Jazan, Saudi Arabia
  • Sarah Abbas Alhussain College of Medicine, İstanbul Üniversitesi-Cerrahpaşa, Istanbul, Turkey
  • Ibrahim Saleh Al Hutaylah Department of Family Medicine, Dammam Medical Complex, Dammam, Saudi Arabia



Quality, Primary care, Management, Health


The provision of care is fragmented in the complex field of health care. In order to fulfil the needs of all groups in healthcare, quality can serve as a common paradigm. For lowering adverse events, enhancing efficiency, and improving patient satisfaction, the evaluation of quality in medical settings is becoming more and more critical. The objective of the healthcare system is to give a specific patient the best care possible from a certified practitioner in the right environment. Quality management in healthcare is the management of system designs, policies, and procedures that reduce, if not completely eradicate, harm while enhancing patient care and outcomes. Quality improvement must be ongoing in order to improve efficiency, patient safety, the delivery of evidence-based healthcare, and health outcomes. Hospitals were early adopters of quality improvement but adopting evidence-based interventions is still difficult in many primary care settings. The purpose of this research is to review the available information about principles and challenges of quality management in primary care. Relationship management, customer focus, effective leadership, employee engagement, process approach, and improvement are few of the principles of quality management. Various challenges including severely departmentalized, bureaucratic, and hierarchical structure, professional autonomy, conflicts between managers and professionals among several others are faced in primary care. Research in future can effectively contribute to addressing challenges and developing guidelines for overcoming these challenges in primary care to ensure best quality healthcare services.


Ellner AL, Phillips RS. The Coming Primary Care Revolution. J General Internal Med. 2017;32(4):380-6.

Shi L. The impact of primary care: a focused review. Scientifica. 2012;2012:432892.

Goetz K, Hess S, Jossen M. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study. BMJ Open. 2015;5(4):e007443.

Salehi A, Jannati A, Nosratnjad S, Heydari L. Factors influencing the inpatients satisfaction in public hospitals: a systematic review. Bali Med J. 2018;7(1):17-26.

Donabedian A. Evaluating the quality of medical care. The Milbank Memorial Fund quarterly. 1966;44(3):166-206.

Rathee M. Quest for quality: pivotal paradigm for healthcare transformation. J IDA North West Delhi Branch. 2016;3(2):55-6.

Rana BK, Behera NS, Nair SB. QCI-Medical laboratory program journey of quality in public medical laboratories": An experience though program evaluation. J Nat Accred Board Hosp Healthcare Providers. 2014;1(1):7-11.

Hudson SM, Hiott DB, Cole J, Davis R, Egan BM, Laken MA. Increasing capacity for quality improvement in underresourced primary care settings. Quality Manag Heal Care. 2014;23(3):155-62.

Aggarwal A, Aeran H, Rathee M. Quality management in healthcare: The pivotal desideratum. J Oral Biol Craniofacial Res. 2019;9(2):180-82.

Dodwad S. Quality management in healthcare. Ind J Publ Heal. 2013;57(3):138-43.

Mutter JB, Liaw W, Moore MA, Etz RS, Howe A, Bazemore A. Core Principles to Improve Primary Care Quality Management. J Am Board Family Med. 2018;31(6):931-40.

Agarwal A, Aeran H, Uniyal S, Nautiyal A. Quality assurance in dentistry: a need in Indian scenario. Int J Oral Health Dentistry. 2015;1(4):172-6.

Rad AMM. The impact of organizational culture on the successful implementation of total quality management. The TQM Magazine. 2006.

Al-Shdaifat EA. Implementation of total quality management in hospitals. Journal of Taibah University Medical Sciences. 2015;10(4):461-6.

Young RA, Roberts RG, Holden RJ. The Challenges of Measuring, Improving, and Reporting Quality in Primary Care. Ann Family Med. 2017;15(2):175-82.

Al-Alawi K, Al Mandhari A, Johansson H. Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study. BMC Heal Serv Res. 2019;19(1):18.

Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf. 2012;21(10):876-84.

Mosadeghrad AM. Obstacles to TQM success in health care systems. Int J Heal Care Qual Assu. 2013;26(2):147-73.




How to Cite

Aljuhani, F. A., Alhejji, A. M., Aljaloud, M. S., Al Shammari, T. H., Aljurbua, A. A., Turkostany, N. S., Alhassan, A. H., Aljuaid, N. N., Jereb, M. M., Alhussain, S. A., & Hutaylah, I. S. A. (2022). Principles and challenges of quality management in primary care. International Journal Of Community Medicine And Public Health, 9(11), 4296–4300.



Review Articles