Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs. This qualitative study using a semi-structured interview defined quality from the

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... of patients, physicians, nurses, and payers associated with a hospital-based women's service line, and how the attributes of quality varied among the multiple groups. The study also described how stakeholders become aware of quality and how they determined a hospital's quality. From the findings of the study, a conceptual framework of quality in women's health was developed. As health care organizations strive to create a unique identity within today's competitive arena, quality has emerged as a focal point for organizational identity. Quality and its continual improvement has become the guiding framework for organizational planning and evaluation. Nowhere is competition for services and service line development more intense than in women's services. Health care lenders recognize the power of women as health care consumers who make many of the decisions about the family's health care plan or where the family will receive care. Women often shop around for quality health care services for themselves and their families. They relate stories about the quality of care they have received to others in their network of friends and family. Quality is an illusive concept. There are many approaches to defining quality, including: (1) a transcendent approach where quality is undefined but evident when it exists; (2) a productbased approach where the product is measured by the quantity of its component attributes; (3) a user-based approach where the measure of quality is its ability to satisfy the customer; (4) a manufacturing-based approach where quality is conformance to standards; and (5) a valuebased approach where quality is excellence at an affordable price. 1 Many authors have described attributes of quality and suggested strategies for measurement. However, many of these definitions are limited in scope to the specific