September 24, 2018 – Professional Practice Model Theorists: Structure-Process-Outcome
Last week’s discussion touched on Bertalanffy’s General System’s Theory and how our healthcare environment is complex with interrelated structures and processes. This week’s focus is on Avedis Donabedian and his groundbreaking work on the theory and practice of quality assurance in health services research. In a 1966 article, Donabedian proposed using structure, process and outcome to evaluate the quality of health care. He believed that structure has an impact on process which in turn impacts outcomes. This triad helps us know what to measure.
The graphic gives a simple explanation of these three components.
Donabedian’s structure-process-outcome can be applied to shared governance. Structure measures include a council charter, the interprofessional composition of the team, establishing set meeting times, comfort of the meeting space, frequency of the meetings, communication strategy and attendance. Process measures include how the council votes, has access to data, sets SMART goals, measures and evaluates interventions and the way work is accomplished. Outcome measures measure the effect of healthcare on the status of the patient, staff, and community.
Discuss your unit/departments structures, processes and outcomes. Do you have the right structures and processes in place to ensure you achieve the best outcomes?
– Janet Leatherwood, CNO.
(2005) NHS improvement: ACT Academy Online library of quality, service improvement and redesign tools, a model for measuring quality care. Retrieved from https://improvement.nhs.uk/documents/2135/measuring-quality-care-model.pdf
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