The Quality System Maturity Scale

Where is your organisation on The Quality System Maturity Scale? Use my scale to start a conversation about the health and effectiveness of your current quality system - and to plan how you'll evolve it to create even better care and experiences for consumers.


Organisational Quality System Maturity Scale (Balding, 2013)

Maturity Level


1. Informal

  • Driven by lone ‘champions’ with an interest in improvement.
  • Lack of systematic approach: random improvement activities based on minimal and poor data.
  • Managerial response to quality problems largely dependent on staff ‘trying harder’.
  • Limited staff input into identifying problems and improvements.  

2. Compliance

  • Focus on compliance with external/funding requirements.
  • Problem based and reactive approach with minimal systematic collection or analysis of data on key issues.
  •  ‘Doing quality’ is staff code for auditing and other data collection with little impact on consumer care.
  • ‘Quality’ seen as the responsibility of the quality manager. 

3. Reactive

  • Focus on risk management and compliance with accreditation and other external requirements.
  • Systematic tracking of key indicators, consumer feedback and incident reporting.
  • Evidence of some system improvement and follow up.
  • No agreed change and improvement model in use. 
  • Reliance on policy change and education as key change tools.
  • Leaders are developed to improve safety.

4. Proactive

  • Quality system is a key component of clinical/quality governance system, with plans for improvement at organisation-wide and local levels.
  • Lack of common and uniting goals with the improvement program comprising a series of (possibly unrelated) monitoring, improvement and redesign projects.
  • Minimum dataset reported across all quality dimensions.
  • Data analysed and reported through organisational levels to the governing body, with evidence of effective systems improvement as a result.
  • Strategies in place for developing leaders to engage staff in improvement across the dimensions of quality, with some consumer input.

5. Strategic

  • The desired quality of the consumer experience at point of care is defined with staff and consumers, and achieving it is a strategic priority.
  • The organisational quality plan is designed and systematically implemented to create the defined quality consumer experience, through developing people and improving systems.
  • Roles and responsibilities at all levels of the organisation for creating the quality consumer experience are described and supported.
  • Governance systems are owned by the governing body and executive team and designed to support staff to create the quality consumer experience.
  • An agreed and consistent model for change and improvement is in use.