Donabedian's seven pillars of quality in health care

Study and research into the quality of health service provision began first in the United States of America. The pioneer of this field was Aventis Donabedian, who was a professor at the Michigan School of Public Health. Donabedian had been given the task of reviewing the research on the assessment of quality in the provision of health services. He was already well known from 1963, with his first publications on this subject. The cornerstone of Donabedian's work is the well-known paper published in 1990 in the journal “Archives of Pathology & Laboratory Medicine”, entitled “The seven pillars of quality”. According to it, the seven pillars are: (1) efficacy, that is, the ability of care under ideal conditions to improve health, (2) effectiveness, the degree to which the attainable improvements in the level of health are understood by society, (3) efficiency, that is, the ability to obtain the greatest improvement in health at the lowest cost, (4) optimality, the most advantageous balance of costs and benefits, (5) acceptability, conformity to the preferences of patients regarding accessibility, the patient-doctor relationship, the amenities, the effects of care and the cost of care, (6) legitimacy, the preferences of the social environment regarding all of the above and (7) equity, fairness in the distribution of care and of its effects on health. In this way Donabedian underlined his conviction that efforts to improve the structures, the processes and the outcome of health care must be inseparably bound up with genuine care and concern for the needs of patients. Sources: 1. Donabedian A. The seven pillars of quality. Arch Pathol Lab Med. 1990 Nov;114(11):1115-8. 2. Ayanian JZ, Markel H. Donabedian''s Lasting Framework for Health Care Quality. N Engl J Med. 2016 Jul 21;375(3):205-7.