“Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with professional knowledge.”  – Institute of Medicine (IOM)

There are three aspects of Healthcare Quality

  1. Measurable Quality
  2. Appreciative Quality
  3. Perceptive Quality

Measurable Quality

  • Compliance with, or adherence to standards.
  • Standards may take the form of practice guidelines or protocols, or they may establish acceptable expectations for organization performance.
  • At their best, however, standards serve as guidelines for excellence.

Appreciative Quality

  • Comprehension and appraisal of excellence beyond minimal standards and criteria, requiring judgments of skilled, experienced practitioners and sensitive caring persons.
  • Peer review bodies rely on the judgments of like professionals in determining the quality and nonquality of specific patientpractitioner interaction.

Perceptive Quality

  • Degree of excellence that is perceived and judged by the recipient or the observer of care rather than by the provider of care.
  • Quality as perceived by the patient is generally based more on the degree of caring expressed by physicians, nurses, and other staff than on the physical environment and technical competence.

According to Avedis Donabedian, structure, process, and outcome are merely kinds of information we use to draw inferences about the quality of care. 


The arrangement of parts of care system or elements that facilitate care. 

  • Resources 
  • Equipment 
  • Number of staff
  • Qualification of staff
  • Work space


Refer to the procedures, methods, means or sequence of steps for providing or delivering care, producing outcomes.

  • Clinical process
  • Care delivery process


Refers to the results of care, adverse or beneficial


  • Short term
  • Complication


  • Long-term health status
  • Activities of daily living


  • Patient / family satisfaction