Purpose of the study: The purpose of this study was to examine whether and how the concepts of quality and sustainability were defined within Swedish healthcare governance. The analysis focused on politically adopted policy documents from Sweden’s 21 regions, where the fundamental goals and definitions for healthcare management were formulated. By applying established theories of governance and quality management, the study explored the conceptual foundations of quality and sustainability in a decentralized welfare system.Methodology: The study was based on a qualitative document analysis using a deductive approach. Politically ratified policies, strategies, and follow-up documents from all 21 Swedish regions were systematically reviewed. The analysis was guided by two complementary theoretical frameworks: the SOS model and Garvin’s quality dimensions, as adapted by Isaksson for sustainability.Main findings: The results show that definitions of quality are more common and more consistent than those of sustainability. Most regions refer—explicitly or implicitly—to the sixdimensional model from the National Board of Health and Welfare, covering safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. However, these definitions vary in interpretation and emphasis, revealing a fragmented understanding of what quality means in practice. In contrast, sustainability is often mentioned but seldom defined. When present, it is typically associated with environmental objectives, with limited reference to social or economic dimensions or to healthcare’s core mission. This indicates that while the language of quality is institutionalized, sustainability remains conceptually underdeveloped within healthcare governance.Practical implications: Clarifying what quality and sustainability mean in healthcare governance is essential for achieving coherent and value-based improvement. The study demonstrates that the SOS model can serve as a structured framework for identifying conceptual gaps, while Garvin’s logics provide interpretive depth to understand the underlying value orientation. A shared conceptual foundation could strengthen strategic alignment, comparability, and learning between regions, supporting more sustainable and patient-centered governance.Originality/value:This study contributes empirical insight into if and how quality and sustainability are defined within Swedish healthcare policy and governance. It shows that conceptual clarity is unevenly developed and argues that clearer, stakeholder-based definitions are needed to support consistent and effective governance. Type of paper: Research paper
Eberhardsson et al. (Wed,) studied this question.