Donabedian Quality Assessment Framework
Introduction
Questions
Introduction
Donabedian’s Quality Assessment framework focuses on health, the subject of care (the patient), and the provider of care. This theory looks at a triad of:
Structure, such as the hospital, clinic, provider qualifications or organizational characteristics.
Process, such as the delivery, coordination, education, protocols, practice style, or standard of care.
Outcomes.
The structures enhance the process that will be used to achieve the quality improvement outcome, which may be either intermediate (that is, simultaneous or short-term) or long-term. In some instances, the care process may not accurately reflect the outcome measure. When the outcome is not achieved, something has occurred in the structure and/or process, or the outcome needs to be evaluated over a longer time period.
Nurses can use this theory as a way to improve quality of care, patient care outcomes, and patient satisfaction by looking at the Nursing Sensitive Quality Indicators.
Three Functions
This figure represents the relationship between the structure (health care providers and organization) and factors that need to be considered to come together to achieve a desired outcome. Patients, providers, and regulators may not have the same view of what health is as an outcome or a behavior. Each may have different reasons for measuring quality outcomes, so the patient, provider, and health need to be viewed as individual energies to achieve the outcome. Three functions are considered: Social, psychological, and physical-psychological.
Example
Consider a nursing sensitive indicator, such as a pressure ulcer. Perhaps the protocol to prevent pressure ulcers was adhered to, but the patient still gets a pressure ulcer. The nurse, patient, and provider need to look objectively at what happened and what needs to be accomplished or changed to create a quality outcome (an absence of pressure ulcers). People, places, and dynamics combine to deliver health care.
There are three functions to consider: Social, psychological, and physical-psychological. The nurse needs to consider all three functions when delivering care and measuring outcomes. The patient’s needs and perceptions need to be taken into consideration so that quality outcomes are achieved.
Physical-psychological function:
How does a pressure ulcer relate to health? Health, patients, and providers would all agree that pressure ulcers are something to be avoided, unlike something like exercising or eating cookies.
How does a provider (the institution or system) think about a pressure ulcer? That is, how was it acquired? Is it a failure? It is somebody else’s problem? Might it depend on the provider (whether at home or in the hospital)?
How should nurses (the individual practitioner) think about pressure ulcers?
Social function:
How might a pressure ulcer impact a person’s sense of self and experience of the world?
Psychological function:
How does a patient think about and experience a pressure ulcer?
Questions
You are the nurse manager in a rapidly growing office-based practice. The office has only one staff member and is not compliant with electronic documentation. The fax and patient charts are in plain view. The average wait time to see the physician is two hours and patients complain that they lose their prescriptions.
Using this information, consider how
structure
(such as the hospital, clinic, provider qualifications, and organizational characteristics) and
process
(such as the delivery, coordination, education, protocols, practice style, or standard of care) may be modified to achieve quality
outcomes
. Then answer the questions below.
Question
1
of
3
What
structure
issues do you need to consider?
Enter your response
Question
2
of
3
What
processes
need to be modified to effectively deal with these structures?
Enter your response
Question
3
of
3
What
outcomes
are desired? What Nursing Sensitive Quality Indicators are involved?
Enter your Donabedian Quality Assessment Framework response
