Donabedian

Avedis Donabedian (1919–2000) was a physician and public health scholar who shaped modern thinking about health care quality. He is best known for the Donabedian model, a framework for evaluating quality that has become foundational in health services research. In a 1966 publication, he proposed that quality can be assessed through three interrelated elements: structure, process, and outcomes.

Structure includes the physical and organizational infrastructure in which care is delivered, such as facilities, equipment, personnel, and governance. Process encompasses the methods of delivering care, including diagnostics, treatments, and preventive services performed in adherence to guidelines and professional standards. Outcomes refer to the results of care on patients' health status, including morbidity, mortality, functional status, recovery, and patient satisfaction.

Key insight is that quality arises from the interaction of these elements; good structure and processes are necessary to achieve favorable outcomes, but measuring outcomes alone may be insufficient. The framework encourages the selection of indicators across all three domains and the use of both quantitative and qualitative evidence.

Impact: It influenced quality assurance programs, accreditation standards, quality improvement initiatives, and policy development across health systems worldwide. Legacy: The Donabedian model remains widely taught in medical education and used by researchers, clinicians, and regulators to diagnose and improve quality. Selected works include his 1966 Milbank Quarterly article and subsequent writings on quality of care.