Health Care Evaluation Frameworks

Evaluation: Critical assessment on as rigorous a basis as possible of degree health service fulfils stated objectives.


Approaches to evaluation:

1) Donebedian:  Donabedian approach to Defining or Evaluating Health Care



  • Beds
  • Staff --> doctors, nurses, porters…
  • Building
  • equipment
  • funding


Activity/use of resources

1. consultation/interpersonal skills
2. Bed occupancy
3. Referral patterns
4. Prescribing practice
5. Admission procedures

How services are delivered organised and used. How resources used?



  • length of hospital stay
  • waiting times
  • discharge rates
  • access
  • effectiveness
  • equity


Effectiveness of activity/change in health status

  • Mortality
  • Morbidity
  • Complication rate
  • Disability
  • Quality of life

Lohr (1988) 5D's of healthcare outcome:

  • Death
  • Disease
  • Disability
  • Dis-satisfaction
  • Discomfort

Donabedian = America GURU of Health Care Analysis


2) Maxwell

Social Acceptability (Humanity) 'the quality of being human'.
Efficiency (cost/benefits)
Relevance to need
Equity - fair d/n

  • aim to evaluate all 7, but impossible to maximise all dimensions
  • multi-disciplinary input

Mnemonic 'SEE REAL'


3) NHS performance assessment framework - (Can use with Maxwell's)

For High Performance Indicators

Health Improvement Public Health
Fair Access ---- Equity
Appropriate Delivery of effective health ---- EBM
Efficiency ---- Finance
Patient/carer experience ---- complaints/survey
Outcome of NHS care ---- audit


4) The Triple Aim:

Donald Berwick and the Institute for Healthcare Improvement (IHI) in the U.S. describes an approach to optimising health system performance based on the principle that new designs must be developed to simultaneously pursue improvement in three dimensions, the “Triple Aim”:

  • Patient experience of care (including quality and satisfaction);
  • Population health; and
  • Per capita cost.


5) Darzi’s definition of quality:

In 2008, Lord Darzi published High Quality Care for All. Lord Darzi defined quality of care as:

  • Clinically effective,
  • Personal (focused on good patient experience) and
  • Safe.




© Rosalind Blackwood 2009, Claire Currie 2016