‘Structure’, ‘Process’ and ‘Outcome’ are three aspects used to assess and compare the quality of healthcare as described in the conceptual model developed by Avedis Donabedian during the 1960s.

Structure

… structure, although it may include administrative and related processes that support and direct the provision of care. It is concerned with such things as the adequacy of facilities and equipment; the qualifications of medical staff and their organization; the administrative structure and operations of programs and institutions providing care; fiscal organization and the like.

Source: Donabedian A (1966) Evaluating the quality of medical care. Milbank Quarterly 44(3, pt2): 166-2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690293/

Process

… the process of care … based on considerations such as the appropriateness, completeness and redundancy of information obtained through clinical history, physical examination and diagnostic tests; justification of diagnosis and therapy; technical competence in the performance of diagnostic and therapeutic procedures, including surgery; evidence of preventive management in health and illness; coordination and continuity of care; acceptability of care to the recipient and so on.

Source: Donabedian A (1966) Evaluating the quality of medical care. Milbank Quarterly 44(3, pt2): 166-2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690293/

Outcome

The outcome of medical care, in terms of recovery, restoration of function and of survival …

Source: Donabedian A (1966) Evaluating the quality of medical care. Milbank Quarterly 44(3, pt2): 166-2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690293/

Example of all three terms in use:

Improving process and structure aspects of healthcare is most likely to increase patients’ overall evaluation of the quality of care as expressed in a global rating. A more sophisticated method of patient reported outcome measurement, with pre- and post-treatment questionnaires and the inclusion of quality-of-life criteria, might lead to higher associations between outcome and the overall evaluation of received care.

Rademakers J, Delnoij D, de Boer D (2011) Structure, process or outcome: which contributes most to patients’ overall assessment of healthcare quality? BMJ Quality and Safety Volume 20, Issue 4. https://qualitysafety.bmj.com/content/20/4/326 http://dx.doi.org/10.1136/bmjqs.2010.042358