Avedis Donabedian
( † 2000 * 1919) connected to the development of quality in health care is closely named Avedis Donabedian. In 1966 he led a publication for assessing the quality of medical service first the concept of quality in the fields of medicine and nursing scientific one. He provides the necessary distinction between structure, process and outcome quality dar. as central dimensions of quality in health care
Concept of quality
Donabedian defined the quality within the health care system as:
"Quality of care is the degree to which matches the actual supply of presupposed criteria for good care"
Quality dimensions
He divided the concept of quality in three mutually dependent standing quality dimensions:
- Structure or potential quality ( structure )
- Process quality (process )
- Quality of results ( outcome).
Donabedian assumes that all three quality dimensions are related and influence each other. The structures act on the processes and these determine the quality of results, which in turn cause changes in the scheduling of processes and structures. The structure serves as the basis for good medical and nursing services and the process quality is to fulfill an essential role in achieving just this.
Because of its clarity and practicality of this approach was first taken up in other areas of health care, and is now also used in the inpatient and outpatient care. He has created a system of order that would have all the efforts of social organizations will be around quality basis, even the law requires the detection of these three quality criteria.
Criticism
For the core processes in health care facilities is a relationship between process and structure is immediately apparent, however, Donabedian takes here a linear relationship, which so does not have to be detectable in practice. A major difficulty lies in the fact that Donabedian assumed that there is a causal relationship between the three dimensions. This would mean that an improvement of the structural and procedural quality would automatically lead to an improvement of the result. However, this is just hard to prove in health care facilities as a perfect implementation of a treatment or care performance does not necessarily provides an optimal treatment outcome. Due to the fact that it can be assumed that disease is not a static, dependent solely on a defined external intervention condition.
Another criticism of the validity Donabedian quality understanding may be that, building on its quality dimensions, many scientists have developed further quality models. The further develop or improve the original model and thus Donabedian model rather play a fundamental role than currently present meaning.