Question

S-P-O Model of Healthcare Quality

You have studied Donabedian's structure-process-outcome (S-P-O) model (Kelly, 2017) of healthcare quality in your textbook readings. Based on your reading, respond to the following:

Analyze and evaluate how quality is defined, measured, and reported with regards to the S-P-O model.

What structural characteristics of the S-P-O model do you think are necessary in creating an effective and efficient process? Why?

Does evidence-based medicine play a role in the S-P-O model and quality outcomes of care? Justify using examples.

Answer 1

Donabedian has three factors, mainly - structure (resources and administration), process (culture and professional co-operation), and outcome (competence development and goal achievement). The structure refers to prerequisites, such as hospital buildings, staff and equipment. Process describes how structure is put into practice, such as specific therapies. Outcome refers to results of processes, results of therapy. The objectives of this study were to analyse whether S – P – O can be used to describe quality systems. The data were analysed with analysis and structural equation modeling. This is the first large quantitative study that applies Donabedian's model to quality systems.

The hospital staff need tools for building organisations to cope with emerging medical technologies and methods. Quality systems provide data that show patients and staff that the departments are working actively and systematically with quality issues. They can also help the staff to develop more efficient routines.

Process describes quality improvement culture and co-operation within and between professions. Outcome refers to evaluation of goal achievement and development of competence related to quality improvement. Achieving evidence-based medicine (EBM) and cultural competence in medicine (CCM) are complementary means to improve quality by virtue of their methods of changing medical practice.

EBM has been to improve quality through the standardization of medical care. EBM has typically been implemented through clinical guidelines, protocols, or best practices, all which are used to standardize, not individualize, patient care. EBM should allow for integrating individual clinical expertise with the best available data.

CCM is the delivery of health services that acknowledges and understands cultural diversity in setting and respects individuals' health beliefs, values, and behaviors. It started with simplistic attempts to teach doctors about population groups, their cultural norms, and especially cultural peculiarities regarding health and health care. CCM aims to improve quality by individualizing, standardizing, health care interactions.

Both EBM and CCM were applied in simplistic ways, both base their recommendations on model information derived from populations or subgroups. EBM guidelines are derived from population-based studies, while early teaching modules on CCM were based on general, or average, health beliefs among subpopulations. EBM experienced a backlash over cookbook medicine, or clinical stereotyping, while CCM experienced a backlash over cultural stereotyping.

Both fields have reinvention and both now proclaim to focus their goals on improving quality by providing patient-centered care. EBM and CCM to work together, EBM can be patient-centered and that CCM can demonstrably improve health outcomes. For example, patients should feel that implementation of EBM makes them feel more listened to, empowered and respected. CCM lead to fewer medical errors and better health outcomes.