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Purpose -The purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the scope of quality management and continuous improvement. Design/methodology/approach -The paper provides a description of the evolution of the three series of healthcare quality awards that have been held to-date in one of the biggest regions of Europe: Andalusia. Findings -Theoretical analysis of an instrument conceived as an institutionalised way of recognizing quality assurance initiatives in the Andalusian Public Health System. At the same time, the article focuses on the importance of using a reference model to ensure that the process of assessing the projects is systematic and rigorous and therefore stands as a guarantee of transparency within a public administration.Research limitations/implications -The ultimate outcome is dependent of the geographical context and the behaviours and perceptions of people that have participated as assessment panels. Practical implications -The conceptual framework provides guidance on what methodology is used to assess the quality projects (process to allocate projects to assessment panels and assessment criteria required) in a complex healthcare system. It serves as a managerial framework to enhance the continuous improvement in all health-related services. Originality/value -The paper contributes to create a structured debate between researchers and healthcare leaders regarding the assessment criteria to evaluate healthcare quality projects.

The paper incorporates all categories of personnel and specialities in a regional healthcare system that covers eight million inhabitants and employs over 90,000 professionals, includes 33 public hospitals, more than 1,500 primary care centres and other healthcare units.