Structure, Process and Outcome

‘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.