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  Total Quality in LASIK (1995)
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Quality in Medicine

 
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4.4 Service-Oriented Quality Models

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 Three different quality models for service are outlined.


4.4.1 The Common Model of Donabedian*
The model of Donabedian is most commonly applied in medicine. It was first presented in 1966 and specifically designed for medical service performance. Donabedian divides quality into three categories: structure, process and outcome.

structure
This contains the qualification of all personnel, the technical equipment, the organisational working conditions, and the possibility of using the supplied performance by the customer.

Bottlenecks in personnel can bring poor quality. Insufficient or outdated technical equipment can lower the quality of service.

process
This refers to the entirety of activities during the actual service production. The delivered quality is measured by comparing the individual actions of the service provider with others or with standards.

outcome
This stands for the change of the actual or future health condition of the patient. The quality of outcome in medical care is most difficult to measure, as a stable final outcome is usually reached a long time after the patient has left the institution.

Donabedian (fig.9) assumes a linearity between the three components. The connection between the process quality and the resulting outcome seems obvious. However, the understanding of how structure quality effects the process quality is rather unclear.


 structure process outcome
Figure 9: Trichotomy of Service Quality by Donabedian
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Compare [NB92p.37f.], [MM87p.190].
 
 
 
 

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