Structure, Process, Outcomes….

Performance appraisal

Donabedian (2005) suggests that evaluation of care can be conceptualized into three
dimensions: structure, processes and outcomes

 Structure refers to the setting in which care is delivered including adequate facilities and
equipment, qualification of care providers, administration structure and operations of
programs. Using this approach, good care settings and supporting structures contribute to good
care. Structure variables are often concrete and accessible, making them relatively easy to
assess. Currently the APN toolkit houses no instruments that investigate structure.

 Process examines how care has been provided in terms of appropriateness, acceptability
completeness or competency. These measurements are typically have more grey area and
are less definite than those obtained through assessing outcomes. Instruments that assess
process variables are categorized under the following headings: communication, patient
knowledge, performance appraisal and quality of care.

 Outcomes refer to the end points of care, such as improvement in function, recovery or
survival. Outcomes are usually concrete and precisely measured. Some drawbacks to using
outcomes to evaluate care include: choosing a relevant outcome to measure and time lapse
required for measurement. As well, there are outcomes like attitudes and satisfaction that are n
precisely measured. Instruments that assess outcome variables are categorized under the
following headings: patients, health providers and organization and health system. Each of
these three types of outcomes contain unique sub-categories