Quality model according to Donabedian

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The quality development in health care is closely connected with the name Avedis Donabedian (* 1919 ; † 2000 ). In 1966 he was the first to scientifically introduce the concept of quality in the fields of medicine and nursing with a publication on the quality assessment of medical services. He represents the necessary distinction between structure, process and result quality as central quality dimensions in health care.

Quality dimensions

He divided the concept of quality into three interdependent quality dimensions:

  • Structure or potential quality (structure)
  • Process quality (process)
  • Outcome quality (outcome).
The structure quality
Structural quality is understood to mean the description of the framework conditions that exist for medical care in individual cases and the skills of the institution required for product creation. On the one hand, the structural quality includes the relatively stable characteristics of the human and material resources used that are available to the service provider. Material or factual framework conditions relate to the technical equipment, the structural equipment, the infrastructure as well as the rooms and work equipment. Personnel resources include the knowledge, skills, competencies, qualifications as well as the basic, advanced and advanced training level of the personnel. On the other hand, the organizational and financial circumstances, e.g. B. means working concepts and legal / contractual provisions under which the medical care process takes place. In addition, the structural quality is shown in the access and use options of the product by the inquiring customer.
The process quality
The quality of the processes relates to the way in which services are provided and thus describes the entirety of all activities that are carried out in the course of the actual creation of the product. It thus includes all medical, nursing and administrative activities that are either directly or indirectly involved in the immediate care process. It includes the implementation of consultations, the medical care process, the handling of care standards and regulations, the admission procedure, care planning and implementation as well as waiting times.
See also : process quality
The quality of the results
The changes in the current and future state of health of the patient, which are related to the previous medical, i. H. are attributable to medical, nursing and administrative actions, understood. The quality of the results is usually assessed by the patient; satisfaction and quality of life are important quality aspects. But the degree of target achievement and adherence to target agreements also serve as synonyms for success in many companies. However, criteria such as the increase in perceived resources, e.g. B. better internal and external cooperation, serve as criteria for the quality of results.

Donabedian assumes that all three quality dimensions are related and influence one another. The structures affect the processes and these determine the quality of results, which in turn will trigger the planning of changes in processes and structures. The structure serves as the basis for good medical and nursing services and the process quality is of particular importance for achieving this.

Because of its clarity and practicability, this concept was initially taken up in other areas of health care and is now also used in inpatient and outpatient care. He created a system of order that should form the basis of all quality efforts by social organizations; even the legislature requires proof of these three quality criteria.

criticism

For the core processes in health care facilities, a connection between process and structure is immediately apparent, but Donabedian assumes a linear relationship here that need not be found in practice. One of the main difficulties lies in the fact that Donabedian assumed that there is a causal relationship between the three dimensions. This would mean that an improvement in the structural and procedural quality would automatically lead to an improvement in the result. However, it is precisely this that is difficult to prove in health facilities, since the perfect implementation of a treatment or care service does not necessarily produce an optimal treatment result. On the basis of the fact that it can be assumed that illness is not a static condition that is solely dependent on a defined external intervention.

Another point of criticism of the validity of Donabedian's understanding of quality can be that, based on its quality dimensions, many scientists have developed further quality models that further develop or improve the original model and thus Donabedian's model is more of a fundamental importance than its current importance.

See also

Individual evidence

  1. ↑ Böcker (2005), p. 8.
  2. ↑ Auer (2004), p. 82 f.
  3. ↑ Zollondz (2006), p. 162.

literature

  • Christoph Auer: Performance Measurement for Customer Relationship Management . Deutscher Universitäts-Verlag, Wiesbaden 2004, ISBN 3-8244-0741-8 .
  • Petra Böcker: Quality management in hospitals - a practice-oriented comparison of quality management systems and assessment procedures . GRIN Verlag, Norderstedt 2005, ISBN 3-638-85371-3 .
  • Hans-Dieter Zollondz: Basics of quality management . Oldenbourg Wissenschaftsverlag, 2006, ISBN 3-486-57964-9 .
  • Harald Blonski, Michael Strausberg (ed.): Process management in care organizations . Schlütersche, Hannover 2003, ISBN 3-87706-678-X .
  • Gabriele Vitt: Care quality is measurable . Schlütersche, Hannover 2002, ISBN 3-87706-684-4 .
  • Bernhard Badura, Johannes Siegrist (Ed.): Evaluation in Health Care . Juventa, 1999, ISBN 3-7799-1185-X .
  • Avedis Donabedian: The Definition of Quality and Approaches to Its Assessment, Explorations in Quality Assessment and Monitoring. Volume 1, Health Administration Press, 1980, ISBN 0-914904-48-5 .

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