Structureprocessoutcome

Structure-process-outcome (SPO) is a framework used to evaluate quality in health care by organizing quality indicators into three domains: structure, process, and outcome. The model was developed by Avedis Donabedian as part of his broader work on health care quality and has become a foundational tool in quality assessment and improvement.

Structure refers to the context in which care is delivered. This includes the health care setting, facilities, equipment, human and organizational resources (such as staffing levels, training, and governance), and the policies and financing that shape care delivery. Structure defines the prerequisites for delivering care and can influence the potential quality of care that is achievable.

Process encompasses the actual delivery of care and the interactions between providers and patients. This includes diagnostic and therapeutic actions, adherence to clinical guidelines, care planning, communication, continuity of care, and timeliness. Process measures assess how care is carried out rather than just what outcomes result.

Outcome covers the effects of care on patients and populations. Outcome measures capture health status changes, functional outcomes, mortality, readmissions, patient satisfaction, and costs. These outcomes reflect the end results of care and are often the primary interest of patients and payers.

In practice, the SPO framework encourages evaluating how structure supports processes, and how processes lead to outcomes. It highlights that strong structures and well-designed processes are necessary to achieve favorable outcomes, but good structures do not automatically guarantee them. The model is widely used in performance measurement, accreditation, and quality improvement, with limitations including attribution challenges and the influence of external factors on outcomes.