“Evaluating the Quality of Medical Care”: Donabedian's Classic Article 50 Years Later
2016; Wiley; Volume: 94; Issue: 2 Linguagem: Inglês
10.1111/1468-0009.12189
ISSN1468-0009
AutoresDonald M. Berwick, Daniel M. Fox,
Tópico(s)Healthcare Policy and Management
Resumo1 It is a masterpiece.With his typical precision and thoroughness, Donabedian covered the entire field of quality measurement as it was understood at the time.To this day, his subheadings would compose an adequate framework for a course syllabus on measuring the performance of health care.Interpreters often oversimplify Donabedian's conceptualization.In 2015, for example, a report issued by the National Academy of Medicine described Donabedian's approach in entirely technocratic terms as a "model of a health system with inputs, processes, and outcomes." 2(p10) But Donabedian was far from a reductionist.In 1998, he told an oral historian that he had "no solutions . . .but everywhere in my work is the admonition, implicit and explicit, [that] this is a good way of thinking about these problems" (See Table 1).Three years later, he said that "systems . . .are enabling mechanisms only.It is the ethical dimension of individuals that is essential to a system's success."Toward the end of his life, Donabedian recognized, and worried about, the ascendancy of what he called an "industrial model" of quality improvement.In an interview just before his death, he famously avowed, "The secret of quality is love.You have to love your patient, you have to love your profession, you have to love your God.
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