Avedis Donabedian
Encyclopedia
Avedis Donabedian was a physician and founder of the study of quality in health care and medical outcomes research
.
and came to Palestine, although the rest of their families perished. His father had recently qualified as a doctor at the American University of Beirut
in Lebanon and soon after set up practice in the small Christian town of Ramallah
, near Jerusalem. Donabedian received his early education at the Friends’ (Quaker) school there and subsequently followed his father in studying medicine at the American University of Beirut.
due to political unrest, he received sponsorship to stay in the USA with his wife and children. He became a non-clinical teacher and researcher at New York Medical College
from 1957 to 1961, when he was recruited by the School of Public Health at the University of Michigan
. He spent the rest of his professional life there, becoming Nathan Sinai Distinguished Professor of Public Health in 1979, and continuing to work as emeritus professor until his death in 2000.
as it appeared through the 1950s and early 1960s and presented his findings in a lengthy paper in 1966 with the title “Evaluating the Quality of Medical Care”. This summation and analysis brought him immediate fame and is still widely cited and read: it was reprinted by The Milbank Quarterly
in 2005. In it he sets out the necessity of examining the quality of health provision in the aspects of structure, process and outcome.
Much of his subsequent work was a detailed exposition of the concepts and methods required to examine these fundamental aspects of health care. He was an early exponent of systems management
in health services. He strove to define every aspect of quality in health systems and proposed models for its measurement in over 100 papers and 11 books. These include access to health care, completeness and accuracy in medical records, observer bias, patient satisfaction, and cultural preferences in health care. The summation of his efforts is found in his trilogy, Explorations in quality assessment and monitoring (1980-85), a massive work of personal scholarship and analytical thought brought to bear on every aspect of health care provision. Here he suggests seven pillars of quality: efficacy, efficiency, optimality, acceptability, legitimacy, equity, and cost.
. He died peacefully at his home in Ann Arbor, Michigan, 15 years later.
His personal philosophy is perhaps best summed up in his statement, “Systems awareness and systems design are important for health professionals, but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love.”
He wrote personal poetry all his life, but none of it was published.
Outcomes research
Health Outcomes Research , also called Outcomes Research, refers to research which investigates the outcomes of health care practices...
.
Early life
Avedis Donabedian was born to Armenian parents from Turkey who escaped the Armenian holocaustArmenian Genocide
The Armenian Genocide—also known as the Armenian Holocaust, the Armenian Massacres and, by Armenians, as the Great Crime—refers to the deliberate and systematic destruction of the Armenian population of the Ottoman Empire during and just after World War I...
and came to Palestine, although the rest of their families perished. His father had recently qualified as a doctor at the American University of Beirut
American University of Beirut
The American University of Beirut is a private, independent university in Beirut, Lebanon. It was founded as the Syrian Protestant College by American missionaries in 1866...
in Lebanon and soon after set up practice in the small Christian town of Ramallah
Ramallah
Ramallah is a Palestinian city in the central West Bank located 10 kilometers north of Jerusalem, adjacent to al-Bireh. It currently serves as the de facto administrative capital of the Palestinian National Authority...
, near Jerusalem. Donabedian received his early education at the Friends’ (Quaker) school there and subsequently followed his father in studying medicine at the American University of Beirut.
Career
Donabedian received the degree of BA in 1940 and MD in 1944 and subsequently worked at the English Mission Hospital in Jerusalem, making a brief trip to England. As local war broke out over the partition of Palestine in 1948, he moved to the American University of Beirut where he occupied a number of teaching positions and became medical officer to the whole university. He became aware of his limitations as an administrator and developed a growing interest in the quality of health provision and in public health. An opportunity arose to study epidemiology and health services administration at Harvard, where he received his MPH degree (magna cum laude) in 1955. Not wishing to return to LebanonLebanon
Lebanon , officially the Republic of LebanonRepublic of Lebanon is the most common term used by Lebanese government agencies. The term Lebanese Republic, a literal translation of the official Arabic and French names that is not used in today's world. Arabic is the most common language spoken among...
due to political unrest, he received sponsorship to stay in the USA with his wife and children. He became a non-clinical teacher and researcher at New York Medical College
New York Medical College
New York Medical College, aka New York Med or NYMC, is a private graduate health sciences university based in Westchester County, New York, a suburb of New York City and a part of the New York Metropolitan Area...
from 1957 to 1961, when he was recruited by the School of Public Health at the University of Michigan
University of Michigan
The University of Michigan is a public research university located in Ann Arbor, Michigan in the United States. It is the state's oldest university and the flagship campus of the University of Michigan...
. He spent the rest of his professional life there, becoming Nathan Sinai Distinguished Professor of Public Health in 1979, and continuing to work as emeritus professor until his death in 2000.
Research and writings
Donabedian collated the growing literature of health services researchHealth services research
Health services research is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care...
as it appeared through the 1950s and early 1960s and presented his findings in a lengthy paper in 1966 with the title “Evaluating the Quality of Medical Care”. This summation and analysis brought him immediate fame and is still widely cited and read: it was reprinted by The Milbank Quarterly
Milbank Quarterly
The Milbank Quarterly is a peer-reviewed journal for the health care sector published since 1923. It has either led, or been in the top three, for impact factor of 49 journals in Health Policy & Services, and of 69 journals in Health Care Sciences & Services since 2003.The Milbank Quarterly is...
in 2005. In it he sets out the necessity of examining the quality of health provision in the aspects of structure, process and outcome.
Much of his subsequent work was a detailed exposition of the concepts and methods required to examine these fundamental aspects of health care. He was an early exponent of systems management
Systems management
Systems management refers to enterprise-wide administration of distributed systems including computer systems. Systems management is strongly influenced by network management initiatives in telecommunications....
in health services. He strove to define every aspect of quality in health systems and proposed models for its measurement in over 100 papers and 11 books. These include access to health care, completeness and accuracy in medical records, observer bias, patient satisfaction, and cultural preferences in health care. The summation of his efforts is found in his trilogy, Explorations in quality assessment and monitoring (1980-85), a massive work of personal scholarship and analytical thought brought to bear on every aspect of health care provision. Here he suggests seven pillars of quality: efficacy, efficiency, optimality, acceptability, legitimacy, equity, and cost.
Personal life
Donabedian had a wife, Dorothy, and three sons. In the preface to his final large book, The Methods and Findings of Quality Assessment and Monitoring (1985), he regrets that “for all these years, my wife and children suffered the inevitable deprivations caused by my constant labors… Home is the aged wanderer they scarcely know, sitting by the domestic hearth, dozing into sleep.” By this time he already had a diagnosis of prostate cancerProstate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
. He died peacefully at his home in Ann Arbor, Michigan, 15 years later.
His personal philosophy is perhaps best summed up in his statement, “Systems awareness and systems design are important for health professionals, but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love.”
He wrote personal poetry all his life, but none of it was published.