Implementation of Business Excellence Models in Healthcare for Quality Assessment: A Systematic Review

The assessment of healthcare facility quality using business excellence models provides valuable information about performance gaps, which can be used to improve performance. Within the excellence framework, the "result" domain presents more challenges in terms of improvement over time. Using European and American business excellence-based models (EFQM and Balridge, respectively), this review aims to highlight the impact of quality assessment on the improvement of healthcare performance results. A literature search was performed using PubMed, SCOPUS, and CINAHL databases. PRISMA guidelines were followed. All the articles were evaluated using the Critical Appraisal Skills Programme (CASP) Tool. Thematic analysis was conducted following Thomas and Harden's approach, and confidence levels were determined using the GRADE-CERQual method. Nine studies were included. Two main themes emerged: 1) the assessment highlighted improvement in some results; and 2) the assessment highlighted areas that need improvement. The assessments focused mostly on customer-based results and least on society-based results. Six out of nine included studies did not show improvement in the desired results after a one-time assessment; however, no recommendations to improve quality were given to the facility after the assessments. Unless there is continuity in the assessment process, the desired results may not improve.