This monograph presents a conceptual framework to help healthcare systems and organizations analyze, plan, build, and sustain efforts to produce quality healthcare. The framework synthesizes more than ten years of QA Project experience assisting in the design and implementation of QA activities and programs in over 25 countries. That experience has shown that the key institutionalization question is often not so much a technical one--how to "do" QA activities--but rather, how to establish a culture of quality within the organization and make QA an integral, sustainable part of the health system. As with any kind of organizational change, the road to institutionalizing QA can be long and complex. This monograph was written to provide practical information to Ministries of Health and other health organizations in their quest for sustainable quality of care. It both describes the components necessary to inculcate a culture of quality and provides practical information on how to facilitate the process necessary to reach this goal. A framework of eight essential elements and a phased process for institutionalization of QA outline the critical aspects and a road map for creating a lasting program to improve the quality of healthcare. The institutionalization framework draws heavily on management literature and organizational change models, as well as QA program experiences in diverse countries. (excerpt)